HESI MH Care

Structuring

create oder and thereby allow a client to become aware of problems

avolition

lack of motivation associated with reduced emotional expression (flat affect)

Alogia

limited speech

An 18-year-old woman is brought to the emergency department by her two roommates after being found unconscious in the bathroom. Laboratory tests are ordered. The nurse reviewing the findings notes that the urinalysis is positive for flunitrazepam. The nurse knows that flunitrazepam is often used for what? a. As a date rape drug b. To control symptoms of psychosis c. To control symptoms of bipolar mania d. To treat hangover symptoms after excessive alcohol consumption

a. As a date rape drug Flunitrazepam, illegal in the United States, has been used in date rapes; the victim is attacked after consuming a drink spiked with the drug. Flunitrazepam is not used to treat psychosis, mania, or hangover symptoms.

A nurse must consider a child's cognitive level of development when providing preoperative teaching. At which stage of Piaget's cognitive theory should the nurse anticipate that a child will experience the greatest fear of surgery? a. Sensorimotor b. Preoperational c. Formal operational d. Concrete operational

b. Preoperational

Anhedonia

loss of enjoyment of things that were formerly enjoyed

Echolalia

repetition of another person's remarks, words, or statements

A nurse is creating a therapy group for low-functioning clients. Which client is the most appropriate member? a. A 77-year-old man with anxiety and mild dementia b. A 52-year-old woman with alcoholism and an antisocial personality c. A 38-year-old woman whose depression is responding to medication d. A 28-year-old man with bipolar disorder who is in a hypermanic state

a. A 77-year-old man with anxiety and mild dementia An older person with mild dementia and anxiety can participate in a low-functioning group in which there is greater structure and staff direction. A depressed client who is responding to medication should be able to participate in a higher-functioning group. An alcoholic, antisocial client or one in a hypermanic state might be disruptive in a low-functioning therapy group.

The biggest problem for an older female client immediately after the sudden death of her husband will probably be her inability to cope with what? a. Anger b. Finances c. Loneliness d. Estrangement

a. Anger Anger at her husband for leaving her may make the client feel guilty for having these feelings. Financial security may or may not be a problem for this client. Loneliness is something she will have to cope with later, depending on her support system; it is not an immediate problem. Estrangement may be something that she will have to cope with later; it is not an immediate problem.

The nurse refers a client to a self-help group. What does the nurse anticipate that a self-help group such as Alcoholics Anonymous (AA) will help its members learn? a. That their problems are not unique b. That they do not need a crutch to lean on c. That their problems are caused by alcohol d. That the group can stop them from drinking

a. That their problems are not unique Sharing problems with others who have similar problems can help one explore feelings and begin to enhance coping abilities. The Twelve Steps of AA guide alcoholics to seek help from a higher power, which may be religious, based in nature, or the group itself. Problem drinking usually is caused by how the drinker feels about himself or herself. Although AA is a support group, it is a self-help support group. The only one who can stop someone from drinking is the person who is drinking.

Projection

assigning your feelings and emotions to other that are unacceptable to yourself

Crisis Intervention

help client put event in perspective and resolve feelings so the individual can resume life within a short time.

Primary gain

reduce anxiety

Occipital lobe

perception of visual input and depth perception

frontal cortex

receives input from all areas of the brain and integrates info about body position, memory, arousal states, and emotions

Anamnesis

recollection of bygone events

Echopraxia

reflecting observed movements rather than speech

Veracity

Ethical principle that requires truthfulness

Intellectualization

using logical explanations without feelings or an affective component

Beneficence

duty to do good and promote the welfare of others

catatonia

state in which client display extreme psychomotor retardation to the point of not talking or moving

Which assessment question will provide the best information regarding a client's risk for waking in the night and interrupted sleep related to lifestyle choices? a. "Do you consider yourself a deep sleeper?" b. "Do you smoke cigarettes, cigars, or a pipe?" c. "Do you adhere to a regular bedtime routine?" d. "Do you keep the television on when you're falling asleep?"

b. "Do you smoke cigarettes, cigars, or a pipe?" Tobacco use leads to nicotine addiction. An addiction to nicotine can result in interrupted sleep as the nicotine level declines through the night; the individual is awakened with mild withdrawal symptoms. Lack of a bedtime routine and the presence of environmental noise will likely cause difficulty in falling asleep rather than in staying asleep. An individual who is a deep sleeper will likely have difficulty awakening rather than staying asleep.

A local business owner asks the mental health nurse to talk with employees about the principles of maintaining mental health in today's world. What is the nurse's primary intervention before planning the approach or content for the discussion? a. Arranging for speakers who can help the employees b. Performing a mental health assessment of the employees c. Encouraging the employees to share how they avoid stress d. Surveying the employees for related topics that interest them

d. Surveying the employees for related topics that interest them Beginning at the learner's level of understanding and including the learner in the planning foster acceptance and stimulate motivation. Arranging for speakers who can help the employees is premature. An outline of topics to be included should be developed first. Although a mental health assessment of the employees may eventually be done, it is not the priority at this time. Encouraging the employees to share how they avoid stress may be helpful; however, including the participants in the initial planning is more important.

Which are the most important assessment data for a nurse to gather from the client in crisis? a. The client's work habits b. Any significant physical health data c. A history of emotional problems in the family d. The client's perception of the circumstances surrounding the crisis

d. The client's perception of the circumstances surrounding the crisis Knowing the client's perception of the circumstances surrounding the crisis helps the nurse determine what the situation means to the client. Work habits, physical health information, and family history of emotional problems should be included in a later assessment, but none is the priority at this time.

Neologisms

new words are coined or old words take on private symbolic meaning

Tangential thinking

person never answers the question or return to the central point of the conversation. It is often seen in people with dementia.

Body dysmorphic disorder

preoccupation with some imagined defect in appearance that causes marked distress and significant impairment in social and occupational function

Sublimation

substitution of a socially acceptable behavior for an unacceptable feeling or drive

Thought blocking

sudden stoppage of spontaneous flow of speaking for no apparent external reason; seen most in clients who experience auditory hallucination

Overcompensation

aka reaction formation. defense mechanism; not a pattern of communication

Certain questions are applicable in determining nursing negligence. a. "Was reasonable care provided?" b. "Was there a breach of nursing duty?" c. "Was there an act of omission that resulted in harm?" d. "Except for the nurse's action, would the injury have occurred?" e. "Did the nurse fully understand the actions would result in harm?"

a. "Was reasonable care provided?" b. "Was there a breach of nursing duty?" c. "Was there an act of omission that resulted in harm?" d. "Except for the nurse's action, would the injury have occurred?" Nursing negligence is described as the failure to do or not do what a reasonably careful nurse would do under the circumstances. The elements that must be present to determine negligence include whether the nurse fulfilled the legal duties to provide reasonable care and foresee a risk of injury under certain circumstances and whether there was a breach of duty and whether any injury resulted if there was a breach of duty. The intentional or unintentional nature of a behavior is determined by an understanding of the actions and their consequences.

A nurse working in a mental health clinic has a caseload composed of a number of individuals and families. Which members of the caseload are at the greatest risk for mental health problems? a. A family with a new baby, a divorced man, and a recently retired older woman b. A student beginning college, a person with a chronic illness, and a newly married couple c. A woman changing jobs, a husband who must travel, and a child who must wear dental braces d. A teenager beginning a new job, a family moving into a new area, and an obese middle-aged man

a. A family with a new baby, a divorced man, and a recently retired older woman According to the Recent Life Changes Questionnaire developed and revised by Homes and Rake, a new baby, divorce, and retirement, combined, have the highest unit rating and therefore the greatest potential to cause stress. Although starting college, dealing with a chronic illness, getting married, starting a job or changing jobs, having a spouse who travels, getting braces, moving, and being obese may all cause some anxiety, usually it is controllable and does not place the individual at high risk for mental health problems.

Which approaches should a nurse use during crisis intervention? a. Active b. Passive c. Reflective d. Interpretive e. Goal directed

a. Active e. Goal directed The nurse should assume an active role in assessing the situation and conduct the interview with authority. During crisis intervention the nurse should be goal directed to help the client cope with the crisis. A passive approach is not appropriate; the client usually needs direction to move forward. A reflective approach might be more appropriate for long-term therapy. An interpretive (analytical) approach is not appropriate for crisis intervention.

A client and the client's spouse are presented with electroconvulsive therapy (ECT) as a treatment option instead of pharmacotherapy after the client experiences adverse effects of medication therapy. The nurse meets with them to discuss the procedure. What should the nurse's first action be? a. Allowing the client and family members to voice feelings, myths, and fantasies about ECT b. Clarifying misconceptions and emphasizing the therapeutic value of the procedure for the depressed individual c. Providing them with a brochure about the treatment and scheduling another time to review and answer their questions d. Completing a detailed medical and psychiatric history and then starting family and client teaching at their level of comprehension

a. Allowing the client and family members to voice feelings, myths, and fantasies about ECT It is most important for the nurse to facilitate a discussion of feelings before teaching, because misconceptions about the presumed effects on the brain, public fears, and lack of accurate information regarding ECT precipitate anxiety. Anxiety interferes with learning. Misconceptions can be clarified only after they are expressed; citing the value of the procedure will be ineffective before fears and feelings are elicited. Although written material should be provided, this is not the first action. Depending on their readiness to learn, another meeting may be necessary to continue teaching. Although teaching should be client and family centered, a structured interview just before teaching will not set the climate for learning to occur.

To help establish a therapeutic nurse-client relationship, the mental health nurse uses various communication techniques to convey a willingness to listen and a genuine desire to view the client and his or her needs in a respectful manner. What is the primary underlying principle guiding this process? a. Caring is the underlying component of nursing that promotes client care. b. Understanding of the psychosocial effects of a specific mental illness is vital to client care. c. Each client has a right to appropriate care directed toward both the client's strengths and weaknesses. The nurse initiates and maintains the nurse-client relationship so as to be therapeutic in its nature.

a. Caring is the underlying component of nursing that promotes client care. Caring is the essential component of nursing that promotes the therapeutic relationship and ultimate growth of the nurse-client relationship and the development of client care that is respectful and genuine in its caring. Although understanding the psychosocial effects of a specific mental illness, directing appropriate care toward the client's strengths and weaknesses, and initiating and maintaining the nurse-client relationship contribute to the nurse-client relationship, they are not statements of the primary principle that serves as the basis of this process.

Assessment data are collected on four different clients being assessed for safety risks to themselves and others. Which client does the nurse identify as being at the greatest risk for violent behavior? a. Client 1: H/o being physically and sexually abused by family member from ages 4-12 years; exhibits stress through hyperactivity b. Client 2: H/o violent behavior when under the influence of ETOH; has been abusing ETOH for 10 years c. Client 3: Currently oriented but displays impaired memory; frequently unable to recognize familiar caregivers d. Client 4: Currently paranoid; suspicious of "FBI agents"

a. Client 1: H/o being physically and sexually abused by family member from ages 4-12 years; exhibits stress through hyperactivity A history of physical or sexual abuse coupled with the tendency to demonstrate hyperactive psychomotor agitation puts this client at the highest risk for violence among the assessed clients. A history of violence when inebriated is a low risk factor, regardless of how long the client has been abusing alcohol. Memory impairment that includes poor recognition of familiar individuals is a moderate risk for violence. Paranoid tendencies directed toward vague individuals or situation pose a moderate risk for violence.

During the eighth session of a therapy group, a member who talks frequently is interrupted by one who doesn't. When the interrupting person is finished talking, the one who usually contributes says, "I'm so glad that you feel like talking today." While saying this, the client sits rigidly and looks angry. How should the nurse respond? a. Comment on the interrupted client's angry behavior and pleasant words. b. State that it appears that these members of the group are not getting along. c. Agree with the interrupted client that it is good to have the quiet client talk. d. Ignore the comment and speak with the talkative member privately about being hostile.

a. Comment on the interrupted client's angry behavior and pleasant words. For this to be a growth process for the group, feelings and behaviors must be explored. It is better to focus on behaviors and feelings than on personalities or the fact that they do not get along. Agreement ignores the covert message, which should be explored to help the client and the group. Commenting on the incongruent verbal and nonverbal behavior may lead to a growth experience for the client and the group.

What does a nurse recall that language development in the autistic child resembles? a. Echolalia b. Stuttering c. Scanning speech d. Pressured speech

a. Echolalia The autistic child repeats sounds or words spoken by others, which is echolalia. Stuttering is a speech disorder in which the same syllable is repeated, usually at the beginning of a word. Scanning speech is associated with neurological disorders, not autism. Pressured speech is rapid, tense, and difficult to interrupt. This is associated with anxiety, not autism.

A nurse is caring for a terminally ill client who is considering signing an "allow natural death" (AND) document rather than the traditional do-not-resuscitate (DNR) order. In light of the process of grieving, what feeling associated with end-of-life decisions is the AND advance directive attempting to alleviate? a. Guilt b. Anger c. Denial d. Sadness

a. Guilt Many bereaved people blame themselves for not following the correct course of action in preventing the death. By framing the death as part of a natural process rather than the removal of an intervention, the nurse lessens the client's guilt. Anger may occur no matter what course of action is taken. Denial of death is less likely to occur when a DNR or AND is signed. Sadness may occur no matter what course of action is taken.

To begin to establish a therapeutic relationship with a withdrawn, reclusive client, what must the nurse do? a. Help the client keep anxiety to a minimum. b. Protect the client from self-destructive tendencies. c. Ascertain what topics are of most interest to the client. d. Obtain a complete history from the family before talking with the client.

a. Help the client keep anxiety to a minimum. Creating an environment that eases anxiety promotes a feeling of security; as this continues, a sense of trust in this individual is established. The client is not exhibiting self-destructive tendencies at this time. Ascertaining what topics are of most interest to the client is less important in the beginning phase of a relationship. Obtaining a complete history from the family before talking with the client is not important in establishing a therapeutic relationship.

The nurse and client have entered the working phase of a therapeutic relationship. What can the nurse expect the client to do during this phase? a. Initiate topics of discussion. b. Focus the conversation on the nurse. c. Repress emotionally charged material. d. Accept limits on unacceptable behavior. e. Express emotions related to transference.

a. Initiate topics of discussion. d. Accept limits on unacceptable behavior. e. Express emotions related to transference. This phase is focused on developing the client's problem-solving skills while addressing the areas in the client's life that are causing problems. The nurse helps clients identify these topics for discussion. Focusing the conversation on the nurse occurs during the orientation phase, before trust is established. Repressing emotionally charged material occurs during the orientation phase, before trust is established. Resistant behaviors usually are overcome by the working phase. During the working phase of a therapeutic relationship trust is established on the basis of mutual respect. Once trust is established the client will feel comfortable enough to express feelings; feelings of transference and countertransference usually awaken during the working phase of a therapeutic relationship.

What should nurses consider when working with depressed young children? a. It is important to include the family in the treatment plan. b. The goal of therapy is for the child to gain insight into problems. c. Depressed children are treated in much the same way as depressed adults. d. Antidepressant medication is the treatment of choice for depressed children.

a. It is important to include the family in the treatment plan. When a young child demonstrates symptoms of emotional discord, usually this is a response to some type of family dysfunction. Because of their cognitive development, children are usually incapable of insight into their problems. Psychiatric interventions are different for children than for adults. Psychotropic medications are not the treatment of choice for children because their side effects are more dangerous in children than in adults.

A young client who has become a mother for the first time is showing signs of being anxious about her new parenting role. With the nurse's encouragement, she joins the new mothers' support group at the local YMCA. What kind of prevention does this activity reflect? a. Primary prevention b. Tertiary prevention c. Secondary prevention d. Therapeutic prevention

a. Primary prevention Primary prevention is directed toward health promotion and prevention of problems. Tertiary prevention is focused on rehabilitation and the reduction of residual effects of illness. Secondary prevention is related to early detection and treatment of problems. There is no category of prevention called therapeutic prevention.

A client has been taking amoxapine for the past 3 months with no improvement. The primary healthcare provider prescribes phenelzine to be given as well. Which is the best response by the nurse? a. Question the prescription and withhold the medication. b. Ask the client about allergies to feathers before giving the first dose. c. Withhold the medication until a specimen for liver enzymes is drawn. d. Remind the client that this medication should be taken with meals and that milk products must be avoided.

a. Question the prescription and withhold the medication. Amoxapine is a tricyclic antidepressant (TCA), and phenelzine is a monoamine oxidase inhibitor (MAOI); TCAs are contraindicated in concomitant use with MAOIs. Although checking for allergies is important, an allergy to feathers is not specific to MAOIs. Blood tests are not done specifically before the administration of MAOIs. Phenelzine does not have to be taken with food. Milk products, with the exception of aged cheeses and yogurt, may be eaten; products containing tyramine must be avoided.

A female client's stream of consciousness is occupied exclusively with thoughts of her mother's death. The nurse plans to help the client through this stage of grieving, which is known as what? a. Resolving the loss b. Shock and disbelief c. Developing awareness d. Restitution and recovery

a. Resolving the loss Resolving a loss is a slow, painful, continuous process until a mental image of the dead person, almost devoid of negative or undesirable features, emerges. The shock-and-disbelief stage is usually dominated by a refusal to accept or comprehend the fact that a loved one has died. The reality of the death and its meaning as a loss, plus anger, dominate this stage. The various rituals of the funeral help to initiate the recovery or restitution stage.

What is a constructive but lengthy method of confronting the stress of adolescence and preventing a negative and unhealthy developmental outcome? a. Role experimentation b. Adherence to peer standards c. Sublimation through schoolwork d. Development of dependence on parents

a. Role experimentation Adolescents learn about who they are by assuming and experiencing a variety of roles; experimentation results in the retention or rejection of behavior and roles. Adherence to peer standards is not constructive; it does not allow experimentation with a variety of roles. Sublimation is not constructive and delays and interferes with the successful completion of the struggle to formulate one's identity. Development of dependence on parents is not constructive; it does not allow the development of independence.

A high school student reports to the school health nurse that the prescribed antidepressant is no longer needed and should be discontinued. What is the best response by the nurse? a. Seeking further information b. Emphasizing the importance of continuing the medication c. Encouraging the student to discuss it with the healthcare provider d. Recommending that the student stop the medication for several days to determine whether it is still needed

a. Seeking further information The nurse needs more information from the adolescent before proceeding. The student may eventually be encouraged to talk to the healthcare provider or be told how important it is to continue the medication, but neither is the priority intervention. Recommending that the client stop the medication for several days to determine whether it is still needed is beyond the legal scope of nursing practice; a prescription for a psychotropic medication should not be altered without prior notification of the healthcare provider.

What manifestations does the nurse expect to identify when taking a health history from a client with moderate dementia? a. Sundowning b. Hypervigilance c. Increased inhibition d. Exaggeration of premorbid traits e. Inability to recognize family members

a. Sundowning d. Exaggeration of premorbid traits Confusion and agitation with an inability to remain asleep that get worse or only occur at night (sundowning) are characteristics of moderate (stage 2) dementia. Moderate dementia is characterized by increasing dependence on environmental and social structures and by increasing psychological rigidity that accentuates previous traits and behaviors. In addition, a lower-functioning frontal lobe may impair judgment that in the past moderated negative traits and behaviors. Although paranoid attitudes may be exhibited, a decrease in cognitive function, disorientation, and loss of memory usually do not lead to hypervigilance. With the decrease in impulse control that is associated with dementia, decreased, not increased, inhibition is usually present. An inability to recognize family members reflects a decline in cognitive function associated with advanced (stage 3) dementia.

A recently hired nurse is caring for several clients on a mental health unit at a local community hospital. The nurse manager is evaluating the nurse's performance. What situation indicates that the nurse-client boundaries of the recently hired nurse are appropriate? a. The nurse shares with the entire treatment team vital information the client disclosed in a private session. b. The nurse is often busy doing other tasks when the client and nurse are scheduled for a counseling session. c. A client enters the therapeutic group late with the nurse's permission even though group rules say that this is not allowed. d. A client's overall behavior is significantly more independent and demonstrates higher function on the days that the nurse is not working.

a. The nurse shares with the entire treatment team vital information the client disclosed in a private session. The nurse is part of the treatment team and must share vital information with its members. When the nurse is underinvolved in the nurse-client relationship, respect and trust, which are necessary for therapy, do not develop. The nurse must not place other responsibilities over the commitment made to the client. A nurse who becomes overinvolved in the nurse-client relationship may bend the rules for a specific client. This is detrimental to that client and other clients who see the preferential treatment. A nurse who becomes overinvolved in the nurse-client relationship may also foster regressive behaviors that make the client more dependent.

A client is admitted to the psychiatric unit with the diagnosis of obsessive-compulsive disorder. The client washes her hands more than 20 times a day, and they are raw and bloody. What defense mechanism does the nurse conclude that the client is using to ease anxiety? a. Undoing b. Projection c. Introjection d. Displacement

a. Undoing

A 17-year-old client is diagnosed with leukemia. Which statements by the teenager reflect Piaget's cognitive processes associated with adolescence? a. "My smoking pot probably caused the leukemia." b. "I'm going to do my best to fight this awful disease." c. "Now I can't go to the prom because I have this stupid disease." d. "I know I got sick because I've been causing a lot of problems at home." e. "This illness is serious, but with treatment I think I have a chance to get better."

b. "I'm going to do my best to fight this awful disease." c. "Now I can't go to the prom because I have this stupid disease." e. "This illness is serious, but with treatment I think I have a chance to get better."

A school-aged child is brought to the clinic by the mother, who states, "Something is very wrong. My child never seems happy and refuses to play." When assessing this child for depressed behavior, what statement should the nurse initially begin with? a. "Tell me about yourself." b. "Let's talk about what you do after school." c. "Can you tell me what's making you so unhappy?" d. "Why does your mother think that you're unhappy?"

b. "Let's talk about what you do after school." A structured but nonthreatening question such as asking what the child does after school avoids beginning with the problem and may put the child at some ease, producing information that may be useful. The statement "Tell me about yourself" is too open and global; the child will probably not know how to answer this question or know where to begin. The child may not know the answer to the question "Can you tell me what's making you so unhappy?" Asking "Why does your mother think that you're unhappy?" will probably produce an "I don't know" response; the focus should be on the child, not the mother.

What action should the nurse manager take when it becomes apparent that communication between the nurse and the client is consistently superficial? a. Assessing the client's ability to understand the nurse's questions b. Evaluating how actively the nurse has been listening to the client c. Reinforcing to the client how important sharing is for successful recovery d. Reviewing how the questioning techniques are being used by the client

b. Evaluating how actively the nurse has been listening to the client Effective active listening is critical to the development of meaningful, therapeutic communication between the nurse and the client. A lack of effective listening on the part of the nurse commonly results in superficial, ineffective communication. Although there may be situations in which assessing the client's cognitive abilities, reinforcing the importance of effective communication, or reviewing communication skills is an appropriate intervention, there are other, more commonly observed barriers to effective therapeutic communication.

A nurse develops a relationship with a client who has bipolar disorder with episodes of mania. The nurse concludes that their therapeutic interaction has entered the working stage when the client does what? a. Identifies goals for the client-nurse interaction b. Explores the effect of bipolar behavior on the family c. Expresses ambivalence about meeting with the nurse d. Informs the nurse that other family members are bipolar

b. Explores the effect of bipolar behavior on the family

A 65-year-old man is admitted to the hospital with a history of depression. The client, who speaks little English and has had few outside interests since retiring, says, "I feel useless and unneeded." The nurse concludes that the client is in which Erikson's developmental stage? a. Initiative versus guilt b. Integrity versus despair c. Intimacy versus isolation d. Identity versus role confusion

b. Integrity versus despair Integrity versus despair is the task of the older adult; the client has difficulty accepting what life is and was, resulting in feelings of despair and disgust. Initiative versus guilt is the task of the preschool-aged child. Intimacy versus isolation is the task of the young adult. Identity versus role confusion is the task of the adolescent.

A client with bipolar disorder has been admitted for alcohol detoxification, and laboratory tests are performed. Which results should prompt the nurse to notify the admitting health care provider? a. Hemocrit: 47% b. Prothrombin time: 13.9 seconds c. Serum albumin: 2.9 g/dL (29 g/L) d. Lithium level: 1.2 mEq/L (1.2 mmol/L) e. Serum sodium: 140 mEq/L (140 mmol/L) f. Blood urea nitrogen: 25 mg/dL (9.0 mmol/L)

b. Prothrombin time: 13.9 seconds c. Serum albumin: 2.9 g/dL (29 g/L) f. Blood urea nitrogen: 25 mg/dL (9.0 mmol/L) The normal blood urea nitrogen concentration ranges from 8 to 20 mg/dL (2.9 to 7.1 mmol/L). An increased level is seen in renal damage. The normal serum albumin concentration ranges from 3.4 to 5.4 g/dL (34 to 54 g/L). A low level is characteristic of liver damage. The normal prothrombin time for someone who is not taking a blood thinning medication is 11 to 13.5 seconds. A prolonged prothrombin time may be the result of liver damage. The therapeutic lithium level ranges from 0.6 to 1.4 mEq/L (0.6 to 1.4 mmol/L). A lithium level of 1.2 mEq/L (1.2 mmol/L) is well within normal limits and requires no intervention. The normal hematocrit ranges from 35% to 47% in females and 42% to 52% in males. The normal sodium range is 136 to 145 mEq/L (136 to 145 mmol/L).

The nurse can best handle personal questions asked by the client in any phase of the nurse-client relationship by doing what? a. Reviewing the positive and negative aspects of the subject b. Providing brief, truthful answers and redirecting the focus of conversation c. Offering an honest, brief expression of personal views on the topic in question d. Reminding the client gently that the nurse's feelings are not the client's concern

b. Providing brief, truthful answers and redirecting the focus of conversation Unless the nurse answers the question, the client will continue to focus on the nurse rather than on the self; the nurse can best redirect after a brief answer. Reviewing the positive and negative aspects of the subject moves the focus to the nurse's opinions rather than the client's feelings. Offering an honest, brief expression of personal views on the subject raised moves the focus to the nurse's opinions rather than the client's feelings. Reminding the client gently that the nurse's feelings are not the client's concern is not therapeutic; the client is being asked to share, and the nurse should also be willing to share.

A nurse approaches a depressed client who has just been admitted to the psychiatric unit and says, "Hello! I'm Andrea, your nurse. I'll introduce you and help you settle in with the others here. We'll also talk about anything that concerns you." How do these statements establish the nurse-client relationship? a. They provide a theme. b. They define boundaries. c. They identify problems. d. They initiate the working phase.

b. They define boundaries. Boundary development and maintenance, safety, and the development of trust are the three basic concepts of an initial therapeutic relationship. Boundaries define and separate the self from the client and indicate one's responsibilities in relation to the other individual. Themes are recurring patterns of interaction with others throughout life. The identification and clarification of problems, the client's position and understanding of the problems, and the nurse's understanding of the problems take place in the working phase of the therapeutic relationship. After boundaries and a sense of safety are developed, trust must be developed; only then can the working phase begin. However, there is no clear delineation between the end of the orientation phase and the beginning of the working phase.

A young client who has just lost her first job comes to the mental health clinic very upset and says, "I just start crying without any reason and without any warning." How should the nurse respond initially? a. "Do you know what makes you cry?" b. "Most of us need to cry from time to time." c. "Crying unexpectedly can be very upsetting." d. "Are you having any other problems at this time?

c. "Crying unexpectedly can be very upsetting." The response "Crying unexpectedly can be very upsetting" identifies the client's feelings. Asking, "Do you know what makes you cry?" is an unrealistic question; the cause of anxiety may not be known. "Most of us need to cry from time to time" moves the focus away from the client. "Are you having any other problems at this time?" disregards the client's comment; it is a direct question that may impede communication.

While supervising the LPN's technique with medication administration, the nurse manager sees the LPN beginning to dispense an incorrect dose. How should the nurse manager respond initially? a. By telling the LPN that an error has been made b. By informing the nursing supervisor that the LPN is unsafe c. By questioning the dosage in the hope that the LPN will identify the error d. By pointing out the error just before the LPN begins to administer the medication

c. By questioning the dosage in the hope that the LPN will identify the error Because the nurse is supervising, not evaluating, the LPN, questioning the dosage rather than pointing out the error is a positive approach that will allow the LPN to grow and help foster a supportive working relationship. Telling the LPN that an error has been made is not the initial intervention; this may become necessary if the LPN does not identify the error without being told. Informing the nursing supervisor is inappropriate and premature. Waiting until just before administration of the incorrect dose puts the client at risk.

During the termination phase of a therapeutic relationship a client misses a series of appointments without any explanation. What should the nurse do? a. Terminate the relationship immediately. b. Explore personal feelings with the supervisor. c. Contact the client to encourage another session. d. Plan to attend the remaining designated meetings.

c. Contact the client to encourage another session. An additional meeting is important to address the client's problem in regard to termination or determine whether there is some other reason for the client's absence. Terminating the relationship immediately will not be therapeutic, because issues will not be resolved. The nurse may want to explore personal feelings with the supervisor; however, the focus should be on the needs of the client. The client may not attend the remaining designated meetings. The nurse must reach out to help the client with the termination process.

A client has had repeated hospitalizations for aggressive, violent behavior. While on the mental health service, the client becomes very angry, starts screaming at the nurse, and pounds the table. What is the priority nursing assessment at this time? a. Range of expressed anger b. Extent of orientation to reality c. Degree of control over the behavior d. Determination of whether the anger is justified

c. Degree of control over the behavior Degree of control over the behavior is the most important assessment because it will influence the nurse's intervention. Depending on the extent of the client's control, the nurse may or may not need assistance. It is not the degree of anger but instead the behavior it precipitates that is important to assess. The extent of orientation to reality may or may not influence the ability to control behavior. Anger is always justifiable to the person; the determination of whether the anger is justified will not help the nurse address the client's behavior.

A nurse is volunteering on the community crisis hotline. What is the final objective of the counseling process? a. Reducing anxiety b. Exploring feelings c. Developing constructive coping skills d. Accomplishing the debriefing process

c. Developing constructive coping skills Past coping behaviors have been inadequate in resolving the current crisis; new coping skills are needed to manage anxiety-producing conflicts. Reduction of anxiety is an early objective. Exploration of feelings is an immediate objective. Accomplishment of the debriefing process is an early objective.

A nurse who suspects that a newly admitted infant is the victim of child abuse assesses the parents' interaction with their baby. What parental behaviors might support the diagnosis of child abuse? a. Displaying sensitivity about their child care ability b. Taking the initiative in meeting their child's needs c. Exhibiting difficulty in showing concern for their child d. Demonstrating heightened interest in their child's welfare e. Procrastinating in obtaining treatment for their child's injuries

c. Exhibiting difficulty in showing concern for their child e. Procrastinating in obtaining treatment for their child's injuries Abusive parents seek gratification of their own needs rather than of their child's needs; they may even project blame for the abuse on their child and find it difficult to conceal their hostility. Abusive parents often delay obtaining help for their child's injuries; the behavior is precipitated by a concern to conceal the injury and a lack of concern for the child. Abusive parents typically have an ill-developed nurturing role and little perception of their parenting inability.

A client from the mental health unit elopes while the registered nurse (RN) and two nursing assistants (NAs) are supervising 12 clients on a fresh-air break. Which best describes how the nurse should handle the situation? a. Get the client who eloped and send both NAs back to the unit with the other clients. b. Send both NAs to follow the client while the RN returns to the unit with the other clients. c. Have one NA trail the patient while the RN and the other NA bring the other clients back to the unit. d. Return to the unit with both NAs and the other clients and then send one NA to find the client who eloped.

c. Have one NA trail the patient while the RN and the other NA bring the other clients back to the unit. Having one NA follow the client while the other team members return the clients to the unit allows the nurse to keep track of the eloped client while ensuring qualified supervision of the remaining clients. As a general rule, one staff member should not attempt to restrain or return a noncooperative client to a unit but should trail the client and alert the other team members to the client's whereabouts. Sending both NAs to follow the client would leave the RN with 11 clients, which could become a problem if another client were to elope or act out. Going after the eloped client leaves the underqualified NAs to supervise the remaining clients. Returning to the unit with both NAs and the remaining clients and then sending one NA to find the client might make it difficult to find the client.

What does the nurse leader expect all members to be doing when a therapy group is achieving its objective? a. Attending every session of the group b. Commenting on each topic discussed by the group c. Making an effort to include one another in discussions d. Following through on obeying rules governing behavior

c. Making an effort to include one another in discussions Making an effort to include one another in discussions demonstrates an increase in socialization and an awareness of the behavior of others. Attendance alone is an insufficient basis for evaluation of the effectiveness of group therapy. The quantity and extent of comments are not significant. Following through on obeying rules governing behavior may indicate a greater degree of impulse control on the part of the members, but this is not the primary goal of group therapy.

A nurse working on a mental health unit is caring for several clients who are at risk for suicide. Which client is at the greatest risk for successful suicide? a. Young adult who is acutely psychotic b. Adolescent who was recently sexually abused c. Older single man just found to have pancreatic cancer d. Middle-age woman experiencing dysfunctional grieving

c. Older single man just found to have pancreatic cancer Older single men with chronic health problems are at the highest risk of suicide. This is because men have fewer social supports than women do. (Men are less social then women in general.) Less social support at times of stress can increase the risk of suicide. Also, chronic health problems can lead to learned helplessness, which can lead to depression. People who are acutely psychotic as a group are at higher risk for suicide, but they do not have the suicide rate of older single adult men with chronic health problems. An adolescent who was recently sexually abused, although severely traumatized, does not have the risk of suicide of an older single man with chronic health problems. Dysfunctional grieving is prolonged grieving that is characterized by greater disability and dysfunctional patterns of behavior. Although people with complicated dysfunctional grieving may be at risk for self-directed violence, they do not have the suicide risk of older single men with chronic health problems.

A nurse expects that when an individual successfully completes the grieving process after the death of a significant other, the individual will be able to do what? a. Accept the inevitability of death. b. Go on with life while forgetting the past. c. Remember the significant other realistically. d. Focus mainly on the good qualities of the person who died.

c. Remember the significant other realistically. Successful resolution means being able to remember the good as well as the bad qualities of the deceased and accepting them as part of the deceased's being human. Resolution involves working through feelings, not just accepting what occurred. Resolution does not mean forgetting; rather it means realistically remembering the past. Focusing mainly on the good qualities of the person who died is an unhealthy response that may become pathologic as a result of the unresolved feelings about the person's other qualities.

A 19-year-old woman, arrested for assault and robbery, has a history of truancy and prostitution but is unconcerned that her behavior has caused emotional distress to others. The diagnosis of antisocial personality disorder is made. According to psychoanalytical theory, the client's lack of remorse and repetitive behavior probably are related to what underdeveloped aspect of personality? a. Id b. Ego c. Superego d. Limbic system

c. Superego Lack of remorse indicates a weak superego, the aspect of personality concerned with prohibitions. The id is not underdeveloped in this person; the id acts to achieve self-gratification. The ego is not related to acting-out behavior. The limbic system is not underdeveloped; it is related to the achievement of pleasure.

What is most important for a nurse to do when initially helping clients resolve a crisis situation? a. Encourage socialization. b. Meet dependency needs. c. Support coping behaviors. d. Involve them in a therapy group.

c. Support coping behaviors. In a crisis situation, the individual frequently just needs support to regroup and re-establish the ability to cope. Socialization is part of recovery; this is not done during the initial stage of a crisis. Meeting dependency needs is not possible or realistic. Involving clients in a therapy group may have the effect of increasing anxiety, thereby making the crisis situation worse.

How can a nurse in the mental health clinic best prepare a client for termination of their therapeutic relationship? a. Periodically summarizing the client's progress during the working phase b. Stating that if the client feels it is necessary, their collaboration may be extended c. Telling the client during their first meeting how long their entire therapeutic relationship will last d. Encouraging an exploration of feelings during the termination phase about the relationship's ending

c. Telling the client during their first meeting how long their entire therapeutic relationship will last A first step in any therapeutic relationship is the setting of parameters, such as time, frequency, and duration, for meetings. Periodic summaries of the client's progress are part of the working phase of a therapeutic relationship and therefore not an initial intervention in the termination phase. The nurse should not deviate from the original contract. Termination issues should be dealt with before the termination phase begins.

A client asks the nurse, "Because I'm so comfortable talking with you, can we go out for coffee and a movie after I get discharged?" To maintain the boundaries of a therapeutic relationship, how will the nurse respond? a. "I'm flattered, but that would be professionally unethical." b. "You feel connected to me now; that will change once you are discharged." c. "The attention I've been giving you is directed toward getting you better; it isn't social." d. "A social life is important, so as your nurse let's talk about how you can form friendships."

d. "A social life is important, so as your nurse let's talk about how you can form friendships." Clients often become socially interested in the nursing staff. When this occurs the nurse should remind the client of the nursing role and take the opportunity to discuss the need for friendships and how to achieve them best. Stating "I'm flattered, but that would be professionally unethical"; "You feel connected to me now; that will change once you are discharged"; and "The attention I've been giving you is directed toward getting you better; it isn't social," although not untrue or inappropriate, do not best address the nursing responsibility in this therapeutic role.

During a phone conversation to a crisis hotline a client states, "I'm falling apart and can't put myself together. This goes on and on." What is the most therapeutic response by the nurse? a. "Is there anyone there with you?" b. "What do you think this means?" c. "How do you usually handle this type of situation?" d. "What's happening right now that prompted you to call?"

d. "What's happening right now that prompted you to call?" Getting the client's perception of what has prompted the call is essential to determining whether the client is in danger. The client has chosen to call the crisis line as a help-seeking behavior; asking whether someone else is there does not focus on the client's reaching out. "What do you think this means?" is a question that can be asked later to assist the client in gaining insight into the present situation. "How do you usually handle this type of situation?" is a question that may follow assessment of the situation.

The nurse identifies that a client is expressing feelings of self-effacement. Which client assessment supports this conclusion? a. Lack of initiative b. Quiet monotone voice c. Aggressive gestures and affect d. Perception that no one is listening

d. Perception that no one is listening A perception that no one is listening conveys to others that the client feels too insignificant for anyone to listen. Initiative and self-effacement are two different factors. A quiet monotone voice indicates feelings of sadness, not self-effacement. Aggressive behaviors are the opposite of self-effacing behaviors.

A psychiatric nurse is working at a community mental health clinic. Which activity demonstrates that the nurse knows the importance of engaging in effective self-awareness? a. Discussing with unit staff the role played by formal religion in personal happiness b. Becoming aware of the cultural practices of the Hispanic clients served by the clinic c. Refusing to engage in a discussion regarding alternative views on physician-assisted suicide d. Accepting a client's decision to refuse electroconvulsive therapy as a treatment for chronic depression

d. Accepting a client's decision to refuse electroconvulsive therapy as a treatment for chronic depression Effective self-awareness is demonstrated by an accepting attitude toward clients' values, beliefs, and decisions when they differ from our own. Although formal religion is a source of happiness for many, it is not an important component of life for everyone. Biases are not acted upon when a nurse is effectively self-aware. Cultural awareness is a component of good nursing practice. Knowledge of cultural practices in and of itself is not a reflection of acceptance, which is a necessary component of self-awareness. Seeking alternative points of view is a characteristic of effective self-awareness because it aids in the acceptance of differing viewpoints.

How should a nurse characterize a sudden terrorist act that causes the deaths of thousands of adults and children and negatively affects their families, friends, communities, and the nation? a. Recurring b. Situational c. Maturational d. Adventitious

d. Adventitious Adventitious crisis - unplanned and accidental: natural disasters, national disasters, and crimes of violence. Recurring crisis - not considered a category in crisis theory. Situational crisis - results from an external source and involves the loss of self-concept or self-esteem of an individual or family group. Maturational crisis - occurs as an individual moves into a new stage of development and prior coping styles are no longer effective; these crises are usually predictable.

A nurse is intervening with a client who is having a crisis. What is the nurse's concern after the initial crisis issues have been addressed? a. Nature of the precipitating factor b. Impact of the situation on significant others c. Client's ability to cope with successive crises d. Client's potential to perform activities of daily living

d. Client's potential to perform activities of daily living Assessment of the client's current status and ability to perform activities of daily living is the priority because it will influence the choice of an appropriate therapeutic regimen. Although the nature of the precipitating factor is significant, this is not the priority at this time and should already have been addressed. Concern now is for the client, not for how the client's behavior affects others. The current crisis must be dealt with first rather than successive crises.

A 76-year-old widower is terminally ill. He is very quiet and is unwilling to have visitors. During the initial contact with this client, what should the nurse do? a. Assess what the client knows about death and the dying process. b. Avoid talking about his condition unless he initiates the discussion. c. Encourage him to accept phone calls from those who wish to visit with him. d. Explore the extent to which he understands his situation and what the information means to him.

d. Explore the extent to which he understands his situation and what the information means to him. A starting point for working with all clients is ascertaining what is known, their understanding of their particular situation, and its meaning to them. It is not merely understanding what death and the dying process means, but also how the individual feels about the current situation. Encouraging conversation about the condition tends to decrease anxiety and is desirable. Encouraging him to accept phone calls from those who wish to visit with him meets the needs of others rather than the client, who is the priority concern.

A team approach is used to help a 6-year-old boy with attention deficit-hyperactivity disorder (ADHD). What behaviors indicate that the interventions have been effective? a. Is not inhibited by rules or routines b. Has fun playing with toys by himself c. Is no longer enuretic during the night d. Has an increased attention span in school e. Is able to wait his turn when in line with others

d. Has an increased attention span in school e. Is able to wait his turn when in line with others One characteristic of children with ADHD is the inability to remain focused on any activity; an increased attention span in school indicates that the child has improved. Other characteristics of children with ADHD are impulsivity, impatience, and the inability to delay gratification; the ability to wait for one's turn in line indicates that the child has improved. A lack of inhibition by rules or routines indicates that the child has not made sufficient progress and his behavior is still impulsive. Having fun playing with toys by himself indicates that the child has not made progress because children should enjoy playing with peers at this age. A 6-year-old child usually does not experience nocturnal enuresis; there are no data to indicate that the child had enuresis.

The husband of a woman who gave birth to a baby 2 weeks ago calls the postpartum unit at the hospital, seeking assistance for his wife. He reports that he found his wife in bed and that the baby was wet, dirty, and crying in the crib. He says, "She says she just can't do it." What is the best response by the nurse? a. Encouraging him to express his feelings about the situation b. Telling him to schedule an appointment with the gynecologist c. Asking whether he can afford a home health aide for several weeks d. Informing him that he should seek emergency intervention for his wife

d. Informing him that he should seek emergency intervention for his wife The inability to care for herself or her infant is a significant sign that the wife is depressed and in need of immediate intervention. The wife, not the husband, is the priority at this time. The wife has an emotional, not physiologic, problem at this time. Asking whether the family can afford a home health aide for several weeks is not the priority at this time; the wife's emotional condition is the priority.

An unmarried pregnant adolescent who is attending a crisis intervention group has decided to continue the pregnancy and keep the baby. What is the crisis intervention nurse's primary responsibility now? a. Praise the client for making a wise decision. b. Explore other problems that the client is experiencing. c. Make an appointment for the client to visit a prenatal clinic. d. Provide information about where the client will be able to get assistance.

d. Provide information about where the client will be able to get assistance. The crisis center nurse's main responsibility is to assist the client in using the problem-solving process; the client should be helped to explore alternative solutions and be given information regarding other agencies, facilities, and services. Although the client's decision should be supported, praising the client is a judgmental response. Exploring other problems that the client may be experiencing is not part of the immediate intervention during the crisis; the client may be encouraged to seek help later for other problems. Making an appointment for the client to visit a prenatal clinic is an option for which the client must take primary responsibility.

A client with a history of violence is becoming increasingly agitated. Which nursing intervention will most likely increase the risk of acting-out behavior? a. Being assertive b. Responding early c. Providing choices d. Teaching relaxation

d. Teaching relaxation Once the client is agitated, teaching will not be effective and may increase the client's anxiety. Teaching relaxation techniques can be done once the client calms down. Being assertive (not aggressive) shows the client that the nurse is confident in handling the situation. This may help reduce the client's anxiety. Responding before agitation escalates makes interventions more likely to be successful. Providing choices may help the client feel less threatened and avoids a power struggle.

The nurse's role in maintaining or promoting the health of the older adult should be based on which principle? a. Some physiologic changes that occur as a result of aging are reversible. b. Thoughts of impending death are common and depressing to most older adults. c. Older adults can better accept the dependent state that chronic illness often causes. d. There is a strong correlation between successful retirement and maintaining health.

d. There is a strong correlation between successful retirement and maintaining health. Individuals who can reflect back on life and accept it for what it was and is, and who can adjust to and enjoy the changes retirement brings, are less likely to develop health problems, especially stress-related health problems. The physiologic changes of aging may not be reversible. Most emotionally healthy older adults are not focused on thoughts of impending death. Dependence is often threatening and not easily accepted by older adults.

Confronting

examines a discrepancy between what a person is saying and what a person dooes

temporal lobe

focus on environmental events and integrates smell and hearing

Secondary gain

gain benefits from others

parietal lobe

receives and integrates info about tast and touch

Perservation

repetitive expression of a single idea in response to different questions; found most often in clients with cognitive impairment and those experiencing catatonia

Somatization disorder

reporting of many physical problems by the client, usually before age 30; physical problems may include pain, GI symptoms, sexual or reproductive problems, and at least symptom that suggest neurological disorder

Undoing

taking some action to counteract or make up for a wrongdoing

Conversion Disorder

the presence of 1/+ symptoms r/t a neurological problem that has no organic cause

Introjection

treating something outside of self as if it is inside the self; unconsciously incorporating the wishes values, and attitudes of another as if they were your own