Mental Health T1 Q&A Part2

Which of the following symptoms would lead a provider to suspect that a client is experiencing PTSD? (Select all that apply.) A.Visiting the scene of the accident over and over B.Talking with strangers about the events of the accident C.Flashbacks of the accident D.Hypervigilance E.Irritability F.Difficulty concentrating G.Mania

C,D,E,G All these symptoms are signs of PTSD. The other options are not associated with signs of PTSD.

A depressed client tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse should identify this cognitive distortion as what response? A.Self-blame B.Catatonia C.Learned helplessness D.Discounting positive attributes

C. Learned helplessness results in depression when the client feels no control over the outcome of a situation. None of the other options demonstrate these feelings.

Of the following environments, which would be most conducive to a therapeutic session? A.The nurses' station B.A table in the coffee shop C.A quiet section of the day room D.The utility room

C. Of the options provided, a quiet corner of the day room offers the safest, quietest, most private environment for a therapeutic encounter. None of the other options offer these characteristics.

What is the physiologic basis for the success of guided imagery? A.β-Endorphin release raises the pain threshold. B.Imagery raises the body level of cortisol and epinephrine. C.The sympathetic nervous system is stimulated to produce a quiet state. D.Brain catecholamines are less available to transmit pain impulses.

A. Guided imagery stimulates release of β-endorphins, a brain chemical that raises the individual's pain threshold. In so doing, the guided imagery is responsible for making the client more comfortable. None of the other options are accurate explanations of this process.

The nurse would address which of the following goals in attempting to establish a therapeutic nurse-client relationship? (Select all that apply.) A.Helping patients examine self-defeating behaviors and test alternatives B. Promoting self-care and independence C. Providing the client with opportunities to socialize D.Assisting patients with problem solving to help facilitate activities of daily living E.Facilitating communication of distressing thoughts and feelings

A,B,D,E Addressing the client's need to socialize is not one of the goals of establishing a therapeutic relationship. The other options are goals addressed in a therapeutic relationship.

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

A,C,D The other options describe the opposite meanings of social and therapeutic relationships.

Which of the following statements represent a nontherapeutic communication technique? (Select all that apply.) A."Why didn't you attend group this morning?" B."From what you have said, you have great difficulty sleeping at night." C."What did your boyfriend do that made you leave? Are you angry at him? Did he abuse you in some way?" D."If I were you, I would quit the stressful job and find something else." E."I'm really proud of you for the way you stood up to your brother when he visited today." F."You mentioned that you have never had friends. Tell me more about that." G."It sounds like you have been having a very hard time at home lately."

A,C,D,E All these options reflect the nontherapeutic techniques of (in order) asking "why" questions; using excessive questioning; giving advice; and giving approval. The other options describe therapeutic techniques of restating, exploring, and reflecting.

Stress can be attributed to stimulation of the hypothalamus-pituitary-adrenal cortex. Which assessment finding would confirm the long-term effects of such stress? (Select all that apply.) A.Insulin resistance B.A high resting heart rate C.Digestive problems D.Chronic muscle tension E.Obesity

A,E Insulin resistance and obesity are considered long-term sequelae of the high blood glucose levels incurred when the body responds to stress. None of the other options are related to the hypothalamus-pituitary-adrenal cortex.

Which statement about antidepressant medications, in general, can serve as a basis for client and family teaching? A.Onset of action is from 1 to 3 weeks or longer. B.They tend to be more effective for men. C.Recent memory impairment is commonly observed. D.They often cause the client to have diurnal variation.

A. A drawback of antidepressant drugs is that improvement in mood may take 1 to 3 weeks or longer. None of the other options provide correct information regarding antidepressant medications.

When preparing to hold an admission interview with a client, the nurse pulls up a chair and sits facing the client with his or her knees almost touching. When the nurse leans in close to speak, the client becomes visibly flustered and gets up and leaves the room. What is the most likely explanation for client's behavior? A.The nurse violated the client's personal space by physically being too close. B.The client has issues with sharing personal information. C.The nurse failed to explain the purpose of the admission interview. D.The client is responding to the voices by ending the conversation.

A. By sitting and leaning in so closely, the nurse has entered into intimate space (0 to 18 inches), rather than social distance. This has likely made the patient may feel uncomfortable with being so close to someone unknown to them. All the other options lack evidence and jump to conclusions regarding the patient's behavior.

What is the focus during clinical supervision? A.The nurse's behavior in the nurse-client relationship B.Analysis of the client's motivation for transferences C.Devising alternative strategies for client growth D.Assisting the client to develop increased independence

A. Clinical supervision helps the nurse look at his or her own behavior and determine more effective approaches to working with clients. None of the other options are associated with clinical supervision.

A depressed, socially withdrawn client tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse can best address this cognitive distortion with which response? A."Let's look at what you just said, that you can 'never do anything right.'" B."Tell me what things you think you are not able to do correctly." C."Is this part of the reason you think no one likes you?" D."That is the most unrealistic thing I have ever heard."

A. Cognitive distortions can be refuted by examining them, but to examine them the nurse must gain the client's willingness to participate. None of the other options examines the underlying cause of the feeling.

When the nurse remarks to a depressed client, "I see you are trying not to cry. Tell me what is happening." The nurse should be prepared to implement which intervention? A.Waiting quietly for the client to reply B.Prompting the client if the reply is slow C.Repeating the question if the client does not answer promptly D.Reviewing the client's medical record to support the client's response

A. Depressed clients think slowly and take long periods to formulate answers and respond. The nurse must be prepared to wait for a reply.

What would a client experience during a progressive relaxation session? A.Instruction in sequential tensing and relaxing of various muscle groups until the entire body is relaxed B.Being attached to a machine that monitors a physical parameter and receiving audible feedback about the state of that parameter C.Having a nurse enter the client's energy field to rebalance it and bring harmony D.Being led into a positive imaginary sensory experience

A. Instruction on sequential tensing and relaxing muscles provides a description of Benson's method of progressive relaxation. Being attached to a machine that uses sound describes biofeedback. Rebalancing an energy field describes therapeutic touch. Positive imaging describes a component of guided imagery.

What factor exerts the greatest influence on the degree to which various life events upset a specific individual? A.The individual's perception of the event B.The individual's degree of spirituality C.The effect of the individual's health-sustaining behaviors D.The amount of social support available to the individual

A. Researchers have looked at the degree to which various life events upset specific individuals. They have found that the perception of a recent life event determines the person's emotional and psychological reactions to it. While the other options may be factors none contribute to the degree of stress than one's perception of the stressor.

Self-help groups are useful for reducing stress because they provide the individual with the stress mediator that take what form? A.Social support B.Cultural support C.Life satisfaction D.Cognitive reframing

A. Self-help groups often provide a high level of social support. Members meet and are encouraged and sustained by others who share the same problem. None of the other options are expected to be provided by the self-help group format.

A patient admitted with anxiety asks, "What exactly are stressors?" What is the nurse's best response to the patient's question? A."Stressors are events that happen that threaten your current functioning and require you to adapt." B."Stressors are complicated neuro stimuli that cause mental illness." C."It's best if you ask questions like that of your provider for a complete answer." D."Instead of focusing on what stressors are, let's explore your coping skills."

A. Stressors are psychological or physical stimuli that are incompatible with current functioning and require adaptation. Stressors are not complicated neuro stimuli; telling the patient to address these questions to her provider fails to educate the patient, which is the nurse's responsibility. Exploring coping skills would be a good intervention at a later time but does not address the patient's question and changes the subject.

A 72-year-old patient diagnosed with Parkinson's disease is demonstrating behaviors associated with anxiety and has had several falls lately and is reluctant to take medications as prescribed. When his provider orders lorazepam, 1 mg PO bid, the nurse questions the prescription based primarily on what fact? A.The client may become addicted faster than younger patients. B.The client is at risk for falls. C.The client has a history of nonadherence with medications. D.The client should be treated with cognitive therapies because of his advanced age.

B. An important nursing intervention is to monitor for side effects of the benzodiazepines, including sedation, ataxia, and decreased cognitive function. In a patient who has a history of falls, lorazepam would be contraindicated because it may cause sedation and ataxia leading to more falls. There is no evidence to suggest that elderly patients become addicted faster than younger patients. A history of nonadherence would not lead to you to question this drug order. Medication and other therapies are used congruently with all age levels.

A nurse teaches a client a technique for examining negative thoughts and restating them in positive ways. What term is used to identify this technique? A.Guided imagery B.cognitive reframing C.wishful thinking D.confrontational assertion

B. Cognitive reframing calls for changing the viewpoint of a situation and replacing it with another viewpoint that fits the facts but is less negative. That description does not apply to any of the other options.

Which statement by a patient who has been taught cognitive reframing indicates that the teaching was successful? A."I do not have the ability to handle that job." B."I can be successful if I do all the things required to learn the job." C."I may be fired from the job but eventually I will find something else to do with my life." D."I can never learn all there is to know for the job."

B. Cognitive reframing changes the individual's perceptions of stress by reassessing a situation and replacing irrational beliefs with more positive self-statements. The other options are all negative cognitive distortions that would prevent the individual from success.

During what stage of the therapeutic nurse-client relationship is a formal or informal contract between the nurse and client established? A.Preorientation B.Orientation C. Working D.Termination

B. Contracting is part of the orientation phase of the relationship. Establishing the operational "rules" provides a foundation for the relationship. This function is not associated with any of the other options.

A new psychiatric technician mentions to the nurse, "Depression seems to be a disease of old people. All the depressed clients on the unit are older than 60 years." How should the nurse respond to this statement? A."That is a good observation. Depression does mostly strike people older than 50 years." B."Depression is seen in people of all ages, from childhood to old age." C."Depression is most often seen among the middle adult age group." D."The age of onset for most depressive episodes is given as 18 years."

B. Depression can occur at any age. Children, adolescents, adults, and the elderly may all experience depression.

What statement about the comorbidity of depression is accurate? A.Depression most often exists in an individual as a single entity. B.Depression is commonly seen in individuals with medical disorders. C.Substance abuse and depression are seldom seen as comorbid disorders. D.Depression may coexist with other disorders but is rarely seen with schizophrenia.

B. Depression commonly accompanies medical disorders. The other options are false statements.

Which of the following statements about dissociative disorders is true? A.Dissociative symptoms are under the person's conscious control. B.Dissociative symptoms are not under the person's conscious control. C.Dissociative symptoms are usually a cry for attention. D.Dissociative symptoms are always negative.

B. Dissociation is involuntary and results in failure of the normal control over a person's mental processes and normal integration of conscious awareness. The other responses are untrue.

Which statement, made by a client diagnosed with dissociative identity disorder, demonstrates effective understanding in response to the question, "What exactly are the 'alters'? your provider told you about?" illustrates that the education you provided has been effective? A."So, alters are based in mysticism and religiosity, such as demons." B."So, alters are separate personalities with their own characteristics that take over during stress." C."So, alters are never aware of each other." D."So, alters are just like me, but they have no memory of the trauma I went through."

B. Dissociative identity disorder appears to be associated with at least two dissociative identity states: one is a state or personality that functions on a daily basis and blocks access and responses to traumatic memories, and another state (also referred to as an alter state) is fixated on traumatic memories. Each alter has its own memories, behavior patterns, and characteristics. Transition from one personality to another (switching) occurs during times of stress. The other responses are incorrect, because alters may be aware of the existence of each other to some degree, and alters are not just like the host—they have different behaviors and memories.

Which client behavior illustrates eustress? A.A college student fails an exam. B.A bride is planning for her wedding. C.A man is laid off from his job. D.An adolescent gets into a fight at school.

B. Eustress is the result of a positive perception toward a stressor, such as having a baby, planning a wedding, or getting a new job. The other options all describe distress, or a negative energy.

A client prescribed a monamine oxidase inhibitor (MOA) has a pass to go out to lunch. Given a choice of the following entrees, the client A.can safely eat B.avocado salad plate. C.fruit and cottage cheese plate. D.kielbasa and sauerkraut. E.liver and onion sandwich.

B. Fruit and cottage cheese do not contain tyramine. Avocados, fermented food such as sauerkraut, processed meat, and organ meat, contain tyramine. Monoamine oxidase inhibitors inhibit the breakdown of tyramine, which can lead to high blood pressure, a hypertensive crisis, and eventually a cerebrovascular accident. This information makes the other options incorrect.

What therapeutic communication technique is the nurse using by asking a newly admitted patient, "Please tell me what was happening that led to your hospitalization here?" A.Using a minimal encourager B.Using an open-ended question C.Paraphrasing D.Reflecting

B. Open-ended questions require more than one-word answers. This question encourages the patient to provide a narrative concerning the circumstances surrounding the need for admission.

When the nurse asks whether a client is having any thoughts of suicide, the client becomes angry and defensive, shouting, "I'm sick of you people! Are you ever do is ask me the same question over and over. Get out of here!" The nurse's response is based on what fact concerning hostility? A.The client is getting better and is able to be assertive. B.The client may be at high risk for self-harm. C.The client is probably experiencing transference. D.The client may be angry at someone else and projecting that anger to staff.

B. Overt hostility is highly correlated with suicide; therefore the patient may be considered high risk, and appropriate precautions should be taken. The other responses are incorrect with no evidence to support them.

A client's daughter states, "My mother lives with me since my dad died 6 months ago. For the past couple of months, every time I need to leave the house for work or anything else, Mom becomes extremely anxious and cries that something terrible is going to happen to me. She seems OK except for these times, but it's affecting my ability to go to work." This information supports that the client may be experiencing which anxiety-related disorder? A.Panic disorder B.Adult separation anxiety disorder C.Agoraphobia D.Social anxiety disorder

B. People with separation anxiety disorder exhibit developmentally inappropriate levels of concern over being away from a significant other. There may also be fear that something horrible will happen to the other person. Adult separation anxiety disorder may begin in childhood or adulthood. The scenario doesn't describe panic disorder. Agoraphobia is characterized by intense, excessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing or in which help might not be available. Social anxiety disorder, also called social phobia, is characterized by severe anxiety or fear provoked by exposure to a social or a performance situation that will be evaluated negatively by others.

A 55-year-old patient recently came to the United States from England on a work visa. The patient was admitted for severe depression following the death of a life partner weeks ago. While discussing the death and its effects the patient shows little emotion. Which of the following explanations is most plausible for this lack of emotion? A.The patient in denial. B.The response may reflect cultural norms. C.The response may reflect personal guilt. D.The patient may have an antisocial personality.

B. Showing little emotion while in distress may be a cultural phenomenon. Some cultures, such as the British and German cultures, tend to value highly the concept of self-control and may show little facial emotion in the presence of emotional turmoil. There is no evidence to suggest the patient's lack of emotion is a result of any of the other options.

Which statement would best show acceptance of a depressed, mute client? A."I will be spending time with you each day to try to improve your mood." B."I would like to sit with you for 15 minutes now and again this afternoon." C."Each day we will spend time together to talk about things that are bothering you." D."It is important for you to share your thoughts with someone who can help you evaluate your thinking."

B. Spending time with the client without making demands is a good way to show acceptance. While not inappropriate, the other options are less accepting.

What is the major reason for the hospitalization of a depressed patient? A.Inability to go to work B.Suicidal ideation C.Loss of appetite D.Psychomotor agitation

B. Suicidal thoughts are a major reason for hospitalization for patients with major depression. It is imperative to intervene with such patients to keep them safe from self-harm. The other options describe symptoms of major depression but aren't by themselves the major reason for hospitalization.

The relaxation response calls upon the initiation of what process? A.Sympathetic activation B.Parasympathetic activation C.Brainstem deactivation D.Increased cortisol production by the adrenals

B. Sympathetic activation prepares the individual for the fight-or-flight response. Parasympathetic activation has the opposite effect. None of the other options would bring about relaxation.

The first stage of the general adaptation syndrome (GAS) can be characterized by which response? A.Eustress B.Fight or flight C.Resistance D.Exhaustion

B. The initial adaptive response of the general adaptation syndrome prepares the individual to fight or flee in the face of acute stress. None of the other options are associated with the initial stage of GAS.

The preferred seating arrangement for a nurse-client interview should incorporate which positioning? A.The nurse behind a desk and the client in a chair in front of the desk. B.The nurse and client sitting at a 90-degree angle to each other. C.The client sitting in a chair and the nurse standing a few feet away. D.The nurse and client sitting facing each other.

B. This arrangement allows the nurse to observe the client but places no barriers between the principals. The two are at the same height, so neither is in an inferior position. Face-to-face seating is a more confrontational arrangement and therefore more anxiety producing.

What is the most helpful nursing response to a client who reports thinking of dropping out of college because it is too stressful? A."Don't let them beat you! Fight back!" B."School is stressful. What do you find most stressful?" C."I know just what you are going through. The stress is terrible." D."You have only two more semesters. You will be glad if you stick it out."

B. This response acknowledges the speaker's perception of school as difficult and asks for further information. This response suggests the nurse is listening actively and is concerned.

A nurse on the psychiatric unit has a past history of alcoholism and has regular meetings with a mentor. Which statement made to the nurse's mentor would indicate the presence of countertransference? A."My patient is being discharged tomorrow. I provided discharge teaching and stressed the importance of calling the help line number should she become suicidal again." B."My patient has been abusing alcohol. I told her that the only way to recover was to go 'cold turkey' and to get away from her dysfunctional family and to do it now!" C."My patient started drinking after 14 years of sobriety. We are focusing on his treatment plan of attending AA (Alcoholics Anonymous) meetings five times a week after discharge." D."My patient, is an elderly woman with depression. She calls me by her daughter's name because she says I remind her of her daughter."

B. This statement indicates countertransference; the nurse may be overidentifying with the patient because of a past history of alcoholism. Providing adamant advice to the patient that, besides being nontherapeutic, may be more relevant to personal past experiences than to the patient's. The discharge teaching for a patient being discharged and focusing on the treatment plan for the alcoholic patient are appropriate and show no signs of countertransference. The patient calling the nurse by her daughter's name is transference rather than countertransference.

A client who presents no danger to himself or to others is forced to take medication against his will. This situation represents A. assault. B. battery. C. defamation. D.invasion of privacy.

B. battery. Battery is the harmful, nonconsensual touching of another person. Forceful administration of medication constitutes battery.

Which assessment monitors the effect of stress attributed to the stimulation of the hypothalamus-pituitary-adrenal cortex? A.Heart rate B.Triglycerides C.Blood glucose levels D.Brain norepinephrine

C. An increase in gluconeogenesis, stimulated by the release of cortisol, ensures that increased amounts of glucose are available to the individual. Increased glucose levels heighten and maintain energy levels to meet the demands of a crisis or stressor. None of the other options are as directly associated with the hypothalamus-pituitary-adrenal cortex.

When the clinician mentions that a client has anhedonia, the nurse can expect that the client will demonstrate what behavior? A.Poor retention of recent events B.A weight loss from anorexia C.No pleasure from previously enjoyed activities D.Difficulty with tasks requiring fine motor skills

C. Anhedonia is the only term that suggests the lack of ability to experience pleasure.

Beck's cognitive theory suggests that the etiology of depression is related to what factor? A.Sleep abnormalities B.Serotonin circuit dysfunction C.Negative processing of information D.S belief that one has no control over outcomes

C. Beck is a cognitive theorist who developed the theory of the cognitive triad of three automatic thoughts responsible for people becoming depressed: (1) a negative, self-deprecating view of oneself; (2) a pessimistic view of the world; and (3) the belief that negative reinforcement will continue. None of the other options are related to this theory.

Which statement concerning syndromes seen in other cultures but not seen in our own, such as piblokto, Navajo frenzy witchcraft, and amok should be considered true? A.Dissociative disorders such as dissociative identify disorders B.Physical disorders, not mental disorders C.Culture-bound syndromes that are not dissociative disorders D.Myths, or rumors, because they have not been sufficiently studied to be classified as real.

C. Certain culture-bound disorders exist in which there is a high level of activity, a trancelike state, and running or fleeing, followed by exhaustion, sleep, and amnesia regarding the episode. These syndromes, if observed in individuals native to the corresponding geographical areas, should be differentiated from dissociative disorders. The other responses are incorrect.

An effective stress-reduction technique a nurse might teach an individual with performance anxiety is A.assertiveness. B.journal keeping. C.deep breathing. D.restructuring and setting priorities.

C. Changing the breathing pattern can be highly effective in aborting or mitigating the high anxiety level associated with performance anxiety. None of the other options are typically associated with anxiety management.

With which client should the nurse make the assessment that not using touch would probably be in the client's best interests? A.A recent immigrant from Russia B.A deeply depressed client C.A Chinese American client D.A tearful client reporting pain

C. Chinese Americans may not like to be touched by strangers since it is a cultural characteristic.

A patient is sitting with arms crossed over his or her chest, his or her left leg is rapidly moving up and down, and there is an angry expression on his or her face. When approached by the nurse, the patient states harshly, "I'm fine! Everything's great." Which statement related to communication should the nurse focus on when working with this patient? A.Verbal communication is always more accurate than nonverbal communication. B.Verbal communication is more straightforward, whereas nonverbal communication does not portray what a person is thinking. C.Nonverbal and verbal communication may be different; nurses must pay attention to the nonverbal communication being presented to get an accurate message. D.Nonverbal communication is about 10% of all communication, and verbal communication is about 90%.

C. Communication is roughly 10% verbal and 90% nonverbal, so nurses must pay close attention to nonverbal cues to accurately assess what the patient is really feeling. The other options are all untrue of verbal and nonverbal communication and are actually the opposite of what is believed of communication.

Assessment of the thought processes of a client diagnosed with depression is most likely to reveal what characteristic? A.Good memory and concentration B.Delusions of persecution C.Self-deprecatory ideation D.Sexual preoccupation

C. Depressed clients never feel good about themselves. They have a negative, self-deprecating view of the world. This characteristic is not associated with any of the other options.

A 38-year-old patient is admitted with major depression. Which statement made by the patient alerts the nurse to a common accompaniment to depression? A."I still pray and read my Bible every day." B."My mother wants to move in with me, but I want to independent." C."I still feel bad about my sister dying of cancer. I should have done more for her!" D."I've heard others say that depression is a sign of weakness."

C. Guilt is a common accompaniment to depression. A person may ruminate over present or past failings. Praying and reading the Bible describes a coping mechanism; the other responses do not describe a common accompaniment to depression.

The nurse is caring for a patient on day 1 post surgical procedure. The patient becomes visibly anxious and short of breath, and states, "I feel so anxious! Something is wrong!" What action should the nurse take initially in response to the patient's actions? A.Reassure the patient that what they are feeling is normal anxiety and do deep breathing exercises with her. B.Use the call light to inquire whether the patient has been prescribed prn anxiety medication. C.Call for staff help and assess the client's vital signs. D.Reassure the patient that you will stay until the anxiety subsides.

C. In anxiety caused by a medical condition, the individual's symptoms of anxiety are a direct physiological result of a medical condition, such as hyperthyroidism, pulmonary embolism, or cardiac dysrhythmias. In this case, Lana is postoperative and could be experiencing a pulmonary embolism, as evidenced by the shortness of breath and anxiety. She needs immediate evaluation for any serious medical condition. The other options would all be appropriate after it has been determined that no serious medical condition is causing the anxiety.

A 4 years old is referred to the outpatient mental health clinic after being in a severe car accident during which the child mother died. The father states that the child is withdrawn, not sleeping, having nightmares, and acts out the car accident over and over again when playing. The child states, "It's my fault because I'm bad." What trauma induced disorder does this data support? A.Adjustment disorder B.Dissociative identity disorder C.Posttraumatic stress disorder (PTSD) D.Acute stress disorder (ASD)

C. PTSD in preschool children may manifest as repetitive play that includes aspects of the traumatic event, social withdrawal, and negative emotions such as fear, guilt, anger, horror, sadness, shame, or confusion. Children may blame themselves for the traumatic event and manifest persistent negative thoughts about themselves. Unlike PTSD, adjustment disorder may be diagnosed immediately or within 3 months of exposure. Responses to the stressful event may include combinations of depression, anxiety, and conduct disturbances. Dissociative identity disorder includes the presence of "alters" or other personalities that take over in times of stress. As compared with PTSD that occurs a month after the trauma, ASD occurs from 3 days and up to 1 month after exposure to a highly traumatic event. Individuals with ASD experience three or more dissociative symptoms either during or after the traumatic event, including the following: a sense of numbing, detachment, or absence of emotional responsiveness; a reduction in awareness of surroundings; derealization (a sense of unreality related to the environment); depersonalization (experience of a sense of unreality or self-estrangement); or dissociative amnesia (loss of memory).

Jacob is a college student whose friend recently committed suicide. Jacob rates his stress as low. Melissa was also friend with the person who committed suicide, but she rates her stress as high. The difference in how Jacob and Melissa rate their stress may be explained by which coping mechanism? A.Projection B.Denial C.Perception D.Repression

C. Perception, which is influenced by gender, culture, age, and life experience, plays a part in how someone will respond to a stress. The perception of a stressor determines the person's emotional and psychological reactions to it. The other options are all defense mechanisms that do not explain the difference in reactions to a stressor.

The client makes the decision to sit about 5 feet away from the nurse during the assessment interview. The nurse can accurately make what assumption about the client's perception of the nurse? A.The nurse is a safe person to interact with. B.The nurse is a new friend. C.They view the nurse as a stranger. D.They view the nurse as a peer.

C. Social distance (4-12 feet) is reserved for strangers or acquaintances. This is often the client's perception of staff during the initial phase of relationship-building. This behavior is not associated with any perception provided by any other option.

Meditation is successful in promoting stress reduction because it brings about which outcome? A.Prevents endorphin release B.changes the client's energy field C.quiets the sympathetic nervous system D.activates the parasympathetic nervous system

C. Sympathetic nervous system stimulation prepares the body for fight or flight in response to stress. Meditation reduces this state of alert by eliciting a relaxation response by creating a hypometabolic state of quieting the sympathetic nervous system. None of the other options accurately describe the process.

A depressed client is noted to pace most of the time, pull at her clothes, and wring her hands. These behaviors are consistent with which term? A.Senile dementia B.Hypertensive crisis C.Psychomotor agitation D.Central serotonin syndrome

C. These behaviors describe the psychomotor agitation sometimes seen in clients with the agitated type of depression. None of the other options are associated so directly with these behaviors.

A client prescribed fluoxetine demonstrates an understanding of the medication teaching when making which statement? A."I will make sure to get plenty of sunshine and not use sunscreen to avoid a skin reaction." B."I will not take any over-the-counter medication while on the fluoxetine." C."I will report any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right away." D."I will report increased thirst and urination to my provider."

C. This describes symptoms of serotonin syndrome, a life-threatening complication of SRRI medication. The other options are incorrect because the patient should be wearing sunscreen to avoid sunburn, may take over-the-counter medications if sanctioned by the provider, and would not have been educated to report increased thirst and urination as a side effect of fluoxetine.

A patient who recently loss a parent begins crying during a one-to-one session with the nurse. Which of the following responses by the nurse illustrates empathy? A."I'm so sorry. My father died 2 years ago, so I know how you are feeling." B."You need to focus on yourself right now. You deserve to take time just for you." C."That must have been such a hard situation for you to deal with." D."I know that you will get over this. It just takes time."

C. This response reflects understanding of the patient's feelings, which is empathy. Feeling sorry for the client represents sympathy, whereas not addressing the patient's concern belittles the patient's feelings of grief she is expressing by changing the subject. Telling the patient she will get over it does not reflect empathy and is closed-ended.

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? A. "You will participate in unit activities and groups daily." B. "You will be given a schedule daily of the groups we would like you to attend." C. "You will attend a psychotherapy group that I lead that will help you care for yourself." D. "You will see your provider daily in a one-to-one session."

C."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.

Which medication is FDA approved for treatment of anxiety in children? A.Sertraline B.Fluoxetine C.Clomipramine D.Duloxetine

D. A few drugs are approved specifically for anxiety and obsessive-compulsive disorders in children and adolescents. The FDA approved the selective SNRI duloxetine (Cymbalta) in 2014 for children aged 7 to 17 years for generalized anxiety disorder. The FDA has approved four medications for use in children with obsessive-compulsive disorder. They are clomipramine (Anafranil), fluoxetine (Prozac), fluvoxamine (Luvox), and sertraline (Zoloft).

A client admitted with major depression and suicidal ideation with a plan to overdose is preparing for discharge and asks you, "Why did I get a prescription for only 7 days of amitriptyline?" The nurse's response is based on what fact? A.Amitriptyline is very expensive, so the patient may have to buy fewer at a time. B.The goal is to see how the client responds to the first week of medication to evaluate its effectiveness. C.The health care provider wants to see whether any side effects occur within the first week of administration. D.Amitriptyline is lethal in overdose.

D. Amitriptyline is a tricyclic antidepressant (TCA); these drugs are known to be lethal in smaller doses than other antidepressants. Because the patient had a plan of overdose, the best course of action is to give a small prescription requiring her to visit her provider's office more often for monitoring of suicidal ideation and plan. Tricyclics are not known to be expensive. Antidepressant therapy usually takes several weeks to produce full results, so the patient would not be evaluated after only 1 week. Side effects are always a consideration but not the most important consideration with TCAs.

A client with hypertension uses an automatic cycling blood pressure cuff with audible changing tones. The client uses relaxation techniques to lower her blood pressure and is informed of her ongoing success by the tone. This process describes A.biofeedback. B.guided imagery. C.therapeutic touch. D.assertiveness training.

D. Biofeedback is a technique for gaining conscious control over unconscious processes. The scenario describes one method that might accomplish this.

Which approach to reducing client stress is most effective in people with low to moderate hypnotic ability? A.Meditation B.Breathing exercises C.Journal keeping D.Biofeedback

D. Biofeedback is usually thought to be most effective in people with low to moderate hypnotic ability. For people with hypnotic ability, meditation, progressive muscle relaxation, and other cognitive-behavioral therapy techniques produce the most rapid reduction in clinical symptoms.

After a client discusses his/her relationship with his/her father, the nurse asks, "Tell me if I'm correct that you feel dominated and controlled by him?" What is the purpose of the nurse's question? A.Eliciting more information B.Encouraging evaluation C.Verbalizing the implied D.Clarifying the message

D. Clarification helps the nurse understand and correctly interpret the client's message. It gives the client the opportunity to correct misconceptions. This is not the purpose of any of the other options.

When discussing her husband, a client shares that "I would be better off alone. At least I would be able to come and go as I please and not have to be interrogated all the time." What therapeutic communication technique is the nurse using when responding, "Are you saying that things would be better if you left your husband?" A.Focusing B.Restating C.Reflection D.Clarification

D. Clarification verifies the nurse's interpretation of the client's message. None of the other options are associated with the verification of the client's meaning.

Dysthymia cannot be diagnosed unless it has existed for what period of time? A.At least 3 months B.At least 6 months C.At least 1 year D.At least 2 years

D. Dysthymia is a chronic condition that by definition has to have existed for longer than 2 years. None of the other options present a sufficient time period.

A recent immigrant to the United States from which country would find direct eye contact a positive therapeutic technique? A.Korea B.Mexico C.Japan D.Germany

D. Eye contact conveys interest to most northern European individuals. Eye contact would be considered intrusive to the others.

Which communication techniques should the nurse use with a client who has been identified as having difficulty expressing thoughts and feelings? A.Using emotionally charged words and gestures B.Offering opinions and avoiding periods of silence C.Asking closed-ended questions requiring "yes" or "no" answers D.Asking open-ended questions and seeking clarification

D. Open-ended questions give the client the widest possible latitude in answering. Also, the client can take the lead in the interview. Seeking clarification helps the client clarify his or her own thoughts and promotes mutual understanding. None of the options provide this support.

The nurse is providing teaching to a preoperative patient just before surgery. The patient is becoming more and more anxious and begins to report dizziness and heart pounding. The patient also appears confused and is trembling noticeably. Considering the scenario, what decision should the nurse make? A.To reinforce the preoperative teaching by restating it slowly. B.Have the patient read the teaching materials instead of providing verbal instruction. C.Have a family member read the preoperative materials to the patient. D.Do not attempt any further teaching at this time.

D. Patients experiencing severe anxiety, as the symptoms suggest, are unable to learn or solve problems. The other options would not be effective because you are still attempting to teach someone who has a severe level of anxiety.

During a therapeutic encounter the nurse remarks to a client, "I noticed anger in your voice when you spoke of your father. Tell me about that." What communication techniques is the nurse using? A.Giving information and encouraging evaluation B.Presenting reality and encouraging planning C.Clarifying and suggesting collaboration D.Reflecting and exploring

D. Reflecting conveys the nurse's observations of the client when a sensitive issue is being discussed. Exploring seeks to examine a certain idea more fully.

A client prescribed a selective serotonin reuptake inhibitor mentions taking the medication along with the St. John's wort daily. The nurse should provide the client with what information regarding this practice? A.Agreeing that this will help the client to remember the medications. B.Caution the client to drink several glasses of water daily. C.Suggest that the client also use a sun lamp daily. D.Explain the high possibility of an adverse reaction.

D. Serotonin malignant syndrome is a possibility if St. John's wort is taken with other antidepressants. None of the other options are relevant to the situation.

During a clinical interview the client falls silent after disclosing that she was sexually abused as a child. The nurse should engage in which intervention in response to the client's silence? A.Quickly break the silence and encourage the client to continue. B.Reassure the client that the abuse was not her fault. C.Reach out and gently touch the client's arm. D.Allow the client to break the silence.

D. Silence is not a "bad" thing. It gives the speaker time to think through a point or collect his or her thoughts. None of the other options will assist with further communication with this client.

A client, whose friend recently committed suicide, asks the nurse about some ways to help cope with the stress regarding the event. Which option should the nurse discuss with the client? A.Isolation for a short time so that the pain isn't reinforced by explaining her feelings over and over B.Antianxiety medication to help her relax C.Starting a hobby to keep her mind off the troubling event D.Talking with friends and attending a loss support group

D. Social supports and support groups are two effective ways to cope with stress and stressful events. Isolation is never a healthy option; talking about feelings usually decreases stress, not increases. There is no evidence to suggest Melissa is anxious. Trying to "keep her mind off" the stressor does not develop coping mechanisms to deal with stress but rather encourages not dealing with the problem.

Consider the nurse-patient relationship on an inpatient psychiatric unit. Which of the following statements made by the nurse reflects an accurate understanding of when the issue of termination should first be discussed? A."You are being discharged today, so I'd like to bring up the subject of termination—discussing your time here and summarizing what coping skills you have attained." B."I haven't met my new patient yet, but I am working through my feelings of anxiety in dealing with a patient who wanted to kill herself." C."Now that we are working on your problem-solving skills and behaviors you'd like to change, I'd like to bring up the issue of termination." D."Now that we've discussed your reasons for being here and how often we will meet, I'd like to talk about what we will do at the time of your discharge."

D. The issue of termination is brought up first in the orientation phase. All the other options describe other phases of the nurse-patient relationship—the termination phase, the preorientation phase, and the working phase.

What tool should the nurse use in assessing the amount of stress a client has experienced in the past year? A.NANDA Handbook B.DSM-IV-TR C.Quick Mental Status Assessment D.Life-Changing Event Questionnaire

D. This questionnaire calls for the client to review events of the past year and score each. This is the only tool listed that assesses stress.

A client has been admitted to your inpatient psychiatric unit with suicidal ideation. In a one-to-one session with the nurse, he shares the terrible guilt he feels over sexually abusing his stepdaughter and wanting to die because of it. Which of the following responses you could make reflects a helpful trait in a therapeutic relationship? A."It's good that you feel guilty. That means you still have a chance of being helped." B."Of course you feel guilty. You did a horrendous thing. You shouldn't even forget what you did." C."The biggest question is, will you do it again? You will end up having even worse guilt feelings because you hurt someone again." D."You are suffering with guilt over what you did. Let's talk about some goals we could work on that may make you want to keep living."

D. This response demonstrates suspending value judgment, a helpful trait in establishing and maintaining a therapeutic relationship. Although it is difficult, nurses are more effective when they don't use their own value systems to judge patients' thoughts, feelings, or behaviors. The other options are all judgmental responses. Judgment on the part of the nurse will most likely interfere with further explorations of feelings and hinder the therapeutic relationship.

A patient is presenting with behaviors that indicate anger. When approached, the patient states harshly, "I'm fine! Everything's great." Which response should the nurse provide to the patient? A."Okay, but we are all here to help you, so come get one of the staff if you need to talk." B."I'm glad everything is good. I am going to give you your schedule for the day and we can discuss how the groups are going." C."I don't believe you. You are not being truthful with me." D."It looks as though you are saying one thing but feeling another. Can you tell me what may be upsetting you?"

D. This response uses the therapeutic technique of clarifying; it addresses the difference between the patient's verbal and nonverbal communication and encourages sharing of feelings. The other options do not address the patient's obvious distress or are confrontational and judgmental. None of the other options provides this support.

During a therapeutic encounter, the nurse makes an effort to ensure the use of two congruent levels of communication. What is the rationale for this? A.The mental image of a word may not be the same for both nurse and client. B.One statement may simultaneously convey conflicting messages. C.Many of the client's remarks are no more than social phrases. D.Content of messages may be contradicted by process.

D. Verbal messages may be contradicted by the nonverbal message that is conveyed. The nonverbal message is usually more consistent with the client's feelings than the verbal message. None of the remaining options are so directly associated with assuring congruency.

Which statement made by a patient demonstrates a healthy degree of resilience? Select all that apply. a. "I try to remember not to take other people's bad moods personally." b. "I know that if I get really mad I'll end up being depressed." c. "I really feel that sometimes bad things are meant to happen." d. "I've learned to calm down before trying to defend my opinions." e. "I know that discussing issues with my boss would help me get my point across."

a,d,e

Recognizing the frequency of depression among the American population, the nurse should advocate for which mental health promotion intervention? a. Including discussions on depression as part of school health classes b. Providing regular depression screening for adolescent and teenage students c. Increasing the number of community-based depression hotlines available to the public d. Encouraging senior centers to provide information on accessing community depression resources

b

When considering stigmatization, which statement made by the nurse demonstrates a need for immediate intervention by the nurse manager? a. "Depression seems to be a real problem among the teenage population." b. "My experience has been that the Irish have a problem with alcohol use." c. "Women are at greater risk for developing suicidal thoughts then acting on them." d. "We've admitted several military veterans with posttraumatic stress disorder this month."

b

Epidemiological studies contribute to improvements in care for individuals with mental disorders by: a. Providing information about effective nursing techniques. b. Identifying risk factors that contribute to the development of a disorder. c. Identifying individuals in the general population who will develop a specific disorder. d. Identifying which individuals will respond favorably to a specific treatment.

b,d

The World Health Organization describes health as "a state of complete physical, mental, and social well being and not merely the absence of disease or infirmity." Which statement is true in regards to overall health? Select all that apply. a. There is no relationship between physical and mental health. b. Poor physical health can lead to mental distress and disorders. c. Poor mental health does not lead to physical illness. d. There is a strong relationship between physical health and mental health. e. Mental health needs take precedence over physical health needs.

b,d

The nurse planning care for a mentally ill client bases interventions on which concept? A. Every client has a certain degree of resilience. B. It is a client right to be treated respectfully. C. Every client comes with experiences that contribute to their problem. D. There are universal fears that are shared by all mentally healthy individuals.

A. 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.

In the Chinese tradition, disease is believed to be caused by what factor? A. Fluctuations in opposing forces B. Outside influences C.Members' disobedience D. Adoption of Western beliefs

A. Fluctuations in opposing forces In the Eastern tradition, disease is believed to be caused by fluctuations in opposing forces. None of the other options are included in the Chinese view of disease.

Which statement best describes the Diagnostic and Statistical Manual, fifth edition (DSM-5) DSM-5? A. It is a medical psychiatric assessment system. B. It is a compendium of treatment modalities. C. It offers a complete list of nursing diagnoses. D. It suggests common interventions for mental disorders.

A. 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.

A therapeutic inpatient milieu will include which characteristic? A. It provides for the client's safety and comfort. B Voluntarily admitted clients are generally allowed additional privileges. C. Rules and behavioral limits are flexibly enforced. D. Staff provide frequent and ongoing negative feedback to clients.

A. 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.

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? A. Nurses B. Social workers C. Clinical psychologists D. Chemical dependency counselors

A. Nurses Nurses are the only caregivers listed who can provide both physical and psychological care for mental health clients.

According to the Western scientific view of health, what causes illness? A. Pathogens B. Energy blockage C. Spirit invasion D. Soul loss

A. Pathogens Disease has a cause (e.g., pathogens, toxins) that creates the effect; disease can be observed and measured. None of the other concepts are considered as illness produced by the Western view of health.

When considering the civil rights of persons diagnosed with mental illness and hospitalized for treatment, which statement is true? A. They are assured the same as those for any other citizen. B. Their rights are altered to prevent use of poor judgment. C. Their rights are always ensured by appointment of a guardian. D. Their rights are limited to provision of humane treatment.

A. 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.

When considering mental illness, recovery is best described to a client by which statement? A. Working, living, and participating in the community B. Never having to visit a mental health provider again C. Being able to understand the nature of the diagnosed illness D. A period of time when signs and symptoms are being managed

A. 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.

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? A. "We will help you make decisions that will keep you safe." B. "I am going to help you shower, so you will not smell so bad." C. "Your pocket knife and nail clippers will be kept in the nurses' station." D. "You will be having a number of tests to help us learn about your condition."

B. "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.

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? A. Impaired sleep patterns B. Denial of anxiety or depression C. Unexplained physical pain D. Recent immigration to the United States

B. 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.

What is the primary advantage of using a case manager when considering the planning and implementation of client care? A. Increases collaborative practice. B. Enhances resource management. C. Increases client satisfaction with care. D. Promotes evidence-based psychiatric nursing.

B. 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.

How can a nurse best differentiate whether an Asian client is demonstrating a mental illness after having attempted suicide? A. Ask the client whether he views himself as being depressed. B. Identify the client's culture's view regarding suicide. C. Explain that suicide is often regarded as a desperate act. D. Assess the client for other examples of depressive behaviors

B. 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.

When considering the ongoing, crucial responsibilities of nurses working on an inpatient psychiatric unit, which activity has highest priority? A. Fostering research B. Maintaining a therapeutic milieu C. Providing sympathetic listening D. Providing constructive negative feedback

B. 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.

What three structural components comprise a nursing diagnosis? A.Problem, outcome, intervention B. Problem, related factors, defining characteristics C. Unmet need, goal, outcome criterion D. Presenting symptom, treatment, goal

B. Problem, related factors, defining characteristics The components of the nursing diagnosis are problem, related factors, and defining.

The nurse who provides therapeutic milieu management supports the clients best by concentrating on which client need? A. Opportunity to act out fears and frustrations B. Providing a safe place to practice coping skills C. Meeting their physical as well as emotional needs D. Encouraging group communication about existing problems

B. 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.

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? A. The inability to achieve her personal goals in the workplace B. Shaming the family by being responsible for the error C. Feeling personally inadequate regarding dependability D. Traditional belief that failure may result in a changed fate

B. 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.

A term is a synonym for the characteristic of genuineness? A.Respect B. Empathy C.Authentic D.Positive regard

C. Genuineness refers the nurse's ability to be open, honest, and authentic in interactions with patients. It is the ability to meet others person-to-person without hiding behind roles. While positive characteristics, none of the other options related to genuineness.

Which statement made by the nurse would acknowledge that they understand the difference between the ethnicity and culture? A."So, ethnicity refers to having the same life goals whereas culture refers to race." B."So, ethnicity refers to norms within a culture, and culture refers to shared likes and dislikes." C. "So, ethnicity refers to shared history and heritage, whereas D. culture refers to sharing the same beliefs and values." D. "So, ethnicity refers to race, and culture refers to having the same worldview."

C. "So, ethnicity refers to shared history and heritage, whereas D. 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.

What client assessment data demonstrates parity related to mental health care? A. The client is admitted for a 72-hour mental hygiene evaluation. B. Advance practice nurse can be certified as psychiatric nurse specialist. C. A client's mental health coverage is equal to his/her medical/surgical coverage. D. A client who has attempted suicide is hospitalized for a mental health evaluation.

C. 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.

Which scenarios describe a HIPAA violation associated with a nurse's behavior? A. An ED (Emergency Department) nurse gives the intensive care unit nurse a client report from a telephone at the nurse's station. B. A nurse on the medical-surgical floor calls a patient's primary care provider to obtain a list of current medications. C. A nurse on the cardiac unit gives report to the nurse on the step-down unit while transporting a client in the staff elevator. D. A nurse on the psychiatric unit gives discharge information to the counseling office regarding a client's outpatient treatment.

C. 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.

Which nursing behavior best demonstrates the concept of cultural competence? A. Acquiring knowledge about different cultures B. Educating patients about the cultural norms of the United States C. Adjusting personal practice to meet the patients' cultural preferences, beliefs, and practices D.Engaging in continuing education classes on culture in the process of becoming culturally competent

C. 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.

Which branch of epidemiology is the nurse involved in when seeking outcomes for patients whose depression was treated with electroconvulsive therapy (ECT)? A. Experimental B. Descriptive C. Clinical D. Analytic

C. 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.

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? A. Acculturation. B. Ethnocentrism. C. Enculturation. D. Cultural encounters.

C. 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.

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? A.Battery B. Defamation of character C. False imprisonment D. Assault

C. 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.

After the death of a client, what rule of confidentiality should be followed by nurses who provided care for the individual? A. Confidentiality is now reserved to the immediate family. B. Only HIV status continues to be protected and privileged. C. Nothing may be disclosed that would have been kept confidential before death. D. The nurse must confer with the next of kin before divulging confidential, sensitive information.

C. 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.

The mental status examination aids in the collection of what type of data? A. Covert B. Physical C. Objective D. Subjective

C. Objective The mental status exam mostly aids in the collection of objective data.

The psychiatric community health nurse engages in secondary prevention when implementing which intervention? A. Visiting a homeless shelter to provide mental health screenings for its clients B. Discussing the need for proper nutrition with a depressed new mother C. Providing stress reduction seminars at the local senior center D. Visiting the home of a client currently displaying manic behavior

C. Providing stress reduction seminars at the local senior center Secondary prevention is aimed at reducing the prevalence of psychiatric disorders. Early identification of problems, screening, and prompt and effective treatment are hallmarks of this level. While it does not stop the actual disorder from beginning, it is intended to delay or avert progression. None of the other options are focused on early identification of problems.

Which right of the client has been violated if he is medicated without being asked for his permission? A. Right to dignity and respect B. Right to treatment C. Right to informed consent D.Right to refuse treatment

C. 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.

The mental health status of a particular client can best be assessed by considering which factor? A. The degree of conformity of the individual to society's norms B. The degree to which an individual is logical and rational C. Status placement on a continuum from health to illness D. Rate of demonstrated intellectual and emotional growth

C. 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.

Which criterion must be met to refer a client to a partial hospitalization program? A. The client is hospitalized at night in an inpatient setting. B. The client must be able to provide his or her own transportation daily. C. The client is able to return home each day. D. The clients are all recovering from an addiction.

C. 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.

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? A. Outpatient B. Emergency C. Voluntarily D. Involuntarily

C. 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.

What term is used to identify the quantitative study of the distribution of mental disorders in human populations? A. mortality B. prevalence C. epidemiology D. clinical epidemiology

C. 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.

Which phase of the nurse-client relationship may cause client anxieties to reappear and past losses to be reviewed? A.Preorientation phase B. Orientation phase C. Working phase D. Termination phase

D. Termination, a stage in which the client must face the loss or ending of the therapeutic relationship, often reawakens the pain of earlier losses. This is not generally associated with the other phases.

In order to be most effective, the community mental health nurse involved in assertive community treatment (ACT) needs to possess which characteristic? A. Knowledge of both national and local political activism B. The ability to cross service systems C. An awareness of own cultural and personal values D. Creative problem-solving and intervention skills

D. Creative problem-solving and intervention skills Creative problem-solving and intervention skills are the hallmark of care provided by the ACT team.

Considering mental health, what term is used to define a deviation from expectations by members of the cultural group?? A. Hostility B. Lack of self-will C. Variation from tradition D. Illness

D. 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.

Which nursing diagnosis for a psychiatric client is correctly structured and worded? A.Hopelessness related to severe chronic depression B. Spiritual distress as evidenced by client stating "God has abandoned me because I'm a bad person" C. Defensive coping related to lack of insight associated with illicit drug use D. Imbalanced nutrition: less than body requirements related to poor self-concept as evidenced by reporting "I'm not worthy of eating"

D. Imbalanced nutrition: less than body requirements related to poor self-concept as evidenced by reporting "I'm not worthy of eating" This diagnosis contains all the required components: problem statement, related factors, and defining characteristics.

What function is shared by advanced practice and general practice psychiatric nurses? A. Prescriptive authority B. Admitting privileges C. Offers consultation services D. Membership on a multidisciplinary team

D. 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.

Which situation demonstrates the nurse functioning in the role of advocate? A. Providing one-to-one supervision for a client on suicide precautions B. Co-leading a medication education group for clients and families C. Attending an in-service education program to obtain recertification in cardiopulmonary resuscitation D. Negotiating with the client's HMO for extension of a 3-day hospitalization to 5 days

D. 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.

Which tool can the novice nurse might refer to when writing nursing outcomes? A. North American Nursing Diagnosis Association (NANDA) B. Joint Commission (formally JCAHO) C. Nursing Interventions Classification (NIC) D. Nursing Outcomes Classification (NOC)

D. Nursing Outcomes Classification (NOC) The Nursing Outcomes Classification is a publication used as a resource across the United States. It is a standardized list of nursing outcomes that gives nurses a way to evaluate the effect of nursing interventions. That is not the function of any of the other options.

The client's priority nursing diagnosis has been established as risk for self-directed violence: suicide related to multiple losses. What is the priority outcome for this client? A.Refrain from attempting suicide. B. Be placed on suicide precautions. C. Attend self-help group daily. D. State absence of feelings of powerlessness.

D. State absence of feelings of powerlessness. Asking the client to define the role of religion in their life allows for discussion related to the other topics.

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? A. The client is demonstrating symptoms of bipolar disorder. B. The client is demonstrating socially deviant behavior. C. The client is engaging in egocentric behaviors. D. The client is not conforming with social norms.

D. 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.

It is not always guaranteed that all clients who are voluntarily admitted to a behavioral health unit will have the right to which privilege? A. Refusal of treatment. B. To send and receive mail. C. To seek legal counsel. D. To access all personal possessions.

D. 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.

Which statement about mental illness is true? a. Mental illness is a matter of individual nonconformity with societal norms. b. Mental illness is present when irrational and illogical behavior occurs. c. Mental illness changes with culture, time in history, political systems, and the groups defining it. d. Mental illness is evaluated solely by considering individual control over behavior and appraisal of reality.

c

A nursing student new to psychiatric-mental health nursing asks a peer what resources he can use to figure out which symptoms are present in a specific psychiatric disorder. The best answer would be: a. Nursing Interventions Classification (NIC) b. Nursing Outcomes Classification (NOC) c. NANDA-I nursing diagnoses d. DSM-5

d

Which statement regarding clients' rights after being voluntarily admitted to a behavioral health unit is true? A. All rights remain intact. B. Only rights that do not involve decision making remain intact. C. The right to refuse treatment is no longer guaranteed. D.All rights are temporarily suspended.

A. All rights remain intact. The hospitalized client is not a convicted criminal thus all civil rights remain intact.

The case manager is demonstrating an understanding of the primary goals of managed care when engaging in which client intervention? A. Arranging for the client to have a screening for prostate cancer B. Notifying the family that the client will require a wheelchair when discharged C. Providing the client with organizations that help defray the cost of prescribed drug D. Arranging for respite care when the client's family needs to attend an out-of-state affair

A. Arranging for the client to have a screening for prostate cancer The goal of managed care is to provide coordination of all health services with an emphasis on preventive care. While appropriate interventions, none of the remaining options focus on preventive care.

A 43-year-old client being seen in the mental health clinic states, "I have always been a practicing Jew, but in the past few months I am questioning everything. I just don't know if I believe in it anymore." Which of the following nursing diagnoses best describes the client's comment? A.Ineffective coping B.Spiritual distress C. Risk for self-harm D.Hopelessness

B.Spiritual distress The client is expressing distress regarding his religion and spiritual well-being. The client could be experiencing ineffective coping, but this does not directly relate to his comment. There is nothing in the client's comment that would lead to the conclusion that the patient is having thoughts of harming himself or experiencing hopelessness.

When a nurse and client meet informally or have an otherwise limited but helpful relationship, what term is used to identify this relationship? A.Crisis intervention B.Therapeutic encounter C.Autonomous interaction D.Preorientation phenomenon

B A therapeutic encounter is a short but helpful interaction between the nurse and client. None of the other options reflect this form of relationship.

Which of the following activities would be considered nursing care and appropriate to be performed by a basic level nurse for a patient suffering from mental illness? a. Treating major depression b. Teaching coping skills for a specific family dynamic c. Conducting psychotherapy d. Prescribing antidepressant medication

b

Which statement demonstrates the nurse's understanding of the effect of environmental factors on a patient's mental health? a. "I'll need to assess how the patient's family views mental illness." b. "There is a history of depression in the patient's extended family." c. "I'm not familiar with the patient's Japanese cultural view on suicide." d. "The patient's ability to pay for mental health services needs to be assessed."

c

When considering the duty to warn and protect third parties, which client statement should the nurse report to the treatment team members? A. "That judge is going to really regret putting me in here." B. "All politicians need to be shot." C. "When I'm elected president, I'll make them all pay for doubting me." D. "The man out there who is laughing at me is going to die."

A. "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.

The nurse assesses the wellness beliefs and values of a client from another culture best when asking which question? A. "What do you think is making you ill?" B. "When did you first feel ill?" C. "How can I help you get better?" D. "Did you do something to cause the illness?"

A. "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.

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. A 37-year-old patient scheduled for discharge in 24 hours wishes to be discharged immediately B. A 75-year-old patient with dementia who demands to be allowed to go back to his own home C. A 21-year-old actively suicidal patient who wants to be discharged to home and do outpatient counseling D. A 32-year-old female patient who wishes to stay in the hospital but whose husband demands that she be discharged into his care

A. 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.

Which statement best explains the term "worldview"? A. Beliefs and values held by people of a given culture about what is good, right, and normal. B. Ideas derived from the major health care system of the culture about what causes illness. C. Cultural norms about how, when, and to whom illness symptoms may be displayed. D. Valuing one's beliefs and customs over those of another group.

A. 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.

According to current information what factor is associated with the most disabling mental disorders? A. Biological influences B. Psychological trauma C. Learned ways of behaving D. Faulty patterns of early nurturance

A. 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.

Most clients who are diagnosed with chronic mental illness are not likely to have their psychiatric mental health experiences covered by which payment method? A. Private insurance B. Medicare C. Medicaid D. Private pay

A. Private insurance Because most health insurance is employer based, few chronically ill clients have private insurance. The other options are examples of ways patients pay for their needed mental health services.

The client's priority nursing diagnosis has been established as risk for self-directed violence: suicide related to multiple losses. What is the priority outcome for this client? A. Refrain from attempting suicide. B. Be placed on suicide precautions. C. Attend self-help group daily. D. State absence of feelings of powerlessness.

A. Refrain from attempting suicide. Refraining from suicidal attempts is the only outcome that addresses the risk for self-directed violence. The absence of a feeling of powerlessness is not appropriate for the stated nursing diagnosis. The remaining options are interventions.

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? A.Autonomy and beneficence B.Advocacy and confidentiality C.Veracity and fidelity D.Justice and humanism

A.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.

What principle forms the basis of nursing outcome planning? A.Individuals have the right to outcomes that is reflective of their abilities. B. Nursing interventions are designed to solve individuals' problems for them. C. The goal of nursing action is to create a dependency between the client and the caregiver. D. Nurses have the best understanding of client problems and so they direct outcome selection.

A.Individuals have the right to outcomes that is reflective of their abilities. Outcome criteria are the hoped-for outcomes that reflect the maximal level of patient health that the patient can realistically achieve through nursing interventions. None of the other options accurately describes the guiding principle of outcome planning.

Which idea held by the nurse would best promote the provision of culturally competent care? A.Western biomedicine is one of several established healing systems. B. Some individuals will profit from use of both Western and folk healing practices. C. Use of cultural translators will provide valuable information into health-seeking behaviors. D. Need for spiritual healing is a concept that crosses cultural boundaries.

A.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.

The primary source for data collection during a psychiatric nursing assessment is the A.client's own words and actions. B. client's family and friends. C.client's nonverbal responses. D.client's medical treatment records.

A.client's own words and actions. The client should always be considered the primary data source. At times, however, the client will be unable to fulfill this role.

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? A. "By becoming active in politics leading to a potential political career." B. "By educating the public on the effects that stigmatizing has on mental health clients." C. "Advocating for laws that would make the involuntary long-term commitment process easier and faster for caregivers of mentally ill persons." D. "Advocating for reduced mental health insurance benefits to discourage abuse of the system by inappropriate psychiatric admissions."

B. "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.

Resilience is characteristic of mental health that allows people to adapt to tragedies, trauma, and loss. Which client behavior demonstrates this characteristic? A. "My mother made decisions about my husband's funeral when I just couldn't do that." B. "Losing my job was hard but my skills will help me get another one." C. "In spite of all the treatment, I know I'll never be really healthy." D. "My kids, happiness is worth any sacrifice I have to make."

B. "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.

Which assessment question would produce data that would help a nurse understand healing options acceptable to a client of a different culture? A. "Is there someone in your community who usually cures your illness?" B. "What usually helps people who have the same type of illness you have?" C. "What questions would you like to ask about your condition?" D. "What sorts of stress are you presently experiencing?"

B. "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.

Which of the following patients would be appropriate to refer to a partial hospitalization program (PHP)? A. A depressed patient with a suicidal plan B. A patient being discharged from an inpatient alcohol rehabilitation unit C. A client who has stopped taking his or her antipsychotic medication and is neglecting his or her basic needs D. Jeff, who has mild depression symptoms and is starting outpatient therapy

B. 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.

Which ethical principle refers to the individual's right to make his or her own decisions? A.Beneficence B. Autonomy C. Veracity D. Fidelity

B. Autonomy Autonomy refers to self-determination, or the right to make one's own decisions. None of the other options are directly related to the client's right to makes decisions.

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? A. Self-control B. Rational thinking C. Learning and productivity D. Positive self-concept

B. 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.

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? A. Alert security to come to the unit for a show of strength B. Request that the client accompany the nurse to the client's room C. Inform the client that restraints will be used if the behavior continues D. Prepare to administer a prn chemical restraint to the client

B. 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.

What nursing action supports a client's right to autonomy? A.Spending time with an extremely anxious client B.Witnessing the informed consent for electroconvulsive therapy from a client C.Spending equal amount of one-on-one time with each client on the unit D.Attending an inservice on a newly approved medication

B.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.

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? A. "Don't be afraid; it means I'm here to help, not hurt, you." B. "Psychiatric mental health nurses care for people with mental illnesses." C. "We have the specialized skills needed to care for those with mental illnesses." D. "The nurses who work in mental health facilities have that title."

C. "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.

Which question asked by a nurse demonstrates the effective implementation of cultural desire when caring for a client from a different culture? A. "Where can I find information on the concept of Yin-Yang?" B. "How do I go about arranging for a Chinese translator?" C. "What can I do to provide ethnic foods that are still low in fat?" D. "How can I explain why we can't provide for his request for acupuncture?"

C. "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.

Which of the following patients meets the criteria for an involuntary admission to a psychiatric mental health unit? A. A 23-year-old college student who has developed symptoms of anxiety and is missing classes and work B. A 30-year-old accountant who has developed symptoms of depression C. 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 D. A 76-year-old retired librarian who is experiencing memory loss and some confusion at times

C. 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.

A nurse is about to interview an older client whose glasses and hearing aid were placed in the bedside drawer for safe keeping. Before beginning the interview, which nursing intervention that will best facilitate data collection? A.Ask the client if she needs her glasses and hearing aid. B. Give the client her glasses and hearing aid. C. Assist the client in putting on glasses and hearing aid. D.Explain the importance of wearing her hearing aid and glasses.

C. Assist the client in putting on glasses and hearing aid. A client whose hearing or sight is impaired may have difficulty providing information if these items have been removed from his or her possession. Assisting the client in wearing these assistive devices is the best initial intervention. None of the other options will be as effective in facilitating the interview.

A nursing diagnosis for a client with a psychiatric disorder serves what purpose with considering the plan of care? A. Justifying the use of certain psychotropic medication. B. Providing data essential for insurance reimbursement. C. Establishing a framework for selecting appropriate interventions. D. Completing the medical diagnostic statement.

C. 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.

The nurse best assesses the client's spiritual life by asking which question? A."Do you practice a specific religion?" B. "To whom do you turn in times of crisis?" C. "Do you attend church regularly?" D. "What role does religion play in your life?"

D. "What role does religion play in your life?" Asking the client to define the role of religion in their life allows for discussion related to the other topics.

The primary goal and benefit of assertive community treatment (ACT) is demonstrated by which situation? A. A client and family members attend counseling sessions together at a neighborhood clinic B. Implementation of a more flexible work schedule for staff C. Improved reimbursement for services provided in the community D. A client diagnosed with schizophrenia has avoided being rehospitalization for 16 months.

D. 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.

Which criterion is essential when the nurse plans nursing interventions designed to meet a specific goal? A. Safe B. Evidence based C. Individualized D. Economical E. Realistic

A,B,C,E Although expense should be considered, interventions are chosen based on being safe, compatible and appropriate, realistic and individualized, and evidence based and not on their economic value.

According to the DSM-V, which statement made by an adult client supports the criteria for generalized anxiety disorder? (Select all that apply.) A. I've been really anxious for at least 2 years now. B. My anxiety has to be genetic; my mom was a terrible worrier too. C. My marriage is in trouble because I'm always so irritable. D. I've had a good physical and my health care provider says I'm in good health. E. Its hard falling asleep and even harder staying asleep; I'm restless all night.

A,C,D,E 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.

A 29-year-old patient has been admitted following a suicide attempt. Which nursing statement illustrates the concept of patient advocacy? A. "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." B. "Dr. Raye, during the admissions interview the patient stated that there is a family history of three other suicide attempts in the past." C. "I'd like you tell me more about your depression and your suicide attempt?" D. "I will take you on a tour of the unit and orient you to the rules so you can get adjusted here."

A. "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.

The nurse is conducting an admission interview with a client who was raped 2 weeks ago. When asked about the rape, the client becomes very anxious and upset and begins to sob. What should be the nurse's response to the client's reaction? A.Push gently for more information about the rape because the information needs to be documented. B. Acknowledge that the topic of the rape is upsetting and reassure the client that it can be discussed at another time when she feels more comfortable. C. Use silence as a therapeutic tool and wait until the client is done sobbing to continue discussing the rape. D. Reassure the client that anything she says to you will remain confidential.

B. Acknowledge that the topic of the rape is upsetting and reassure the client that it can be discussed at another time when she feels more comfortable. The best atmosphere for conducting an assessment is one with minimal anxiety on the patient's part. If a topic causes distress, it is best to abandon the topic at that time. It is important not to pry or push for information that is difficult for the patient to discuss. The use of silence continues to expect the patient to discuss the topic now. Reassurance of confidentiality continues to expect the patient to discuss the topic now.

Which of the following structural safety precautions is most important when attempting to prevent a common type of inpatient suicide? A. Break-away closet bars to prevent hanging B. Bedroom and dining areas with locked windows to prevent jumping C. Double-locked doors to prevent escaping from the unit D. Platform beds to prevent crush injuries

B. Bedroom and dining areas with locked windows to prevent jumping 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.

When a nurse says, "I work with a mobile mental health unit," what assumption can a client accurately make about the care being provided? A. The patients who are convicted criminals sentenced to home confinement. B. Care is provided to clients in unconventional settings. C. Care is provided by a preferred provider for a large HMO. D. The patients are provided for by a clinical specialist with the visiting nurse service.

B. 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.

When considering client rights, which client can be legally medicated against his or her wishes? A. The client has accepted the medication in the past. B. The client may cause imminent harm to himself or others. C. The client's primary provider orders the medication. D. The client's mental illness may relate to cognitive impairment.

B. 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.

What assumption can be made about the client who has been admitted on an involuntary basis? (Select all that apply.) A. The client can be discharged from the unit on demand of next of kin. B. For the first 48 hours, the client can be given medication over objection. C. The client has failed to agree to fully participate in treatment and care planning. D.The client is a danger to self or others or unable to meet basic needs. E.The commitment was court ordered.

C,D,E 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.

A 17-year-old patient confides to the nurse that they have been thinking of ways to kill a peer. What response should the nurse give when the patient states, "you have to keep it a secret because its confidential information"? A."I will keep it a secret, but you and I need to discuss ways to deal with this situation appropriately without committing a crime." B. "Yes, I will keep it confidential. We have laws to protect patients' confidentiality." C. "Issues of this kind have to be shared with the treatment team and your parents." D. "I will have to share this with the treatment team, but we will not share it with your parents."

C. "Issues of this kind have to be shared with the treatment team and your parents." Although adolescent patients request confidentiality, issues of sexual abuse, threats of suicide or homicide, or issues that put the patient at risk for harm must be shared with the treatment team and the parents. A threat of this nature must be discussed with the treatment team and the parents. Confidentiality laws do not protect information that would lead to harm to the patient or others.

A 26-year-old patient is brought to the emergency room by a friend. The patient is unable to give any coherent history. Which response should the nurse provide when the patient's friend offers to provide information regarding the patient? A."I'm sorry, but I cannot take any information from you as it would violate confidentiality laws." B.There is no need for that as I will call his primary care provider to obtain the information we need." C."Yes, I will be happy to get any information and history that you can provide." D."Yes, however, we will have to get a release signed from the patient for you to be able to talk with me."

C."Yes, I will be happy to get any information and history that you can provide." The friend is a secondary source of information that will be helpful since the patient is not able to give any history or information at this time. Confidentiality laws do not prohibit obtaining information from a secondary source. The friend can provide information and/or history immediately and may be able to relate events that happened just before coming to the hospital. A release would not be necessary to take information about the patient from a secondary source, and a psychotic patient would not be competent to sign a release.

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? A. Autonomy B. Veracity C.Fidelity D. Justice

C.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.

A nurse states, "I am so frustrated trying to communicate with clients when they insist on speaking in their language instead of English. I think if people want to live here, they ought to have to speak our language and act like we do!" Which response by a peer best promotes culturally competent care? (Select all that apply.) A."You are right, but all patients do have a right to an interpreter, so you need to comply." B. "I agree that it is frustrating. We should work with their family members to help convince them to speak English." C."They will have to learn to speak English eventually to live and work successfully in this country. Just try to be patient and encourage them to try speaking English." D."What you are saying is actually considered cultural imposition, which is imposing our own culture onto someone from a different culture." E."When their ability to speak and understand English is very limited, we need to have an interpreter present to make sure they can make their needs and feelings known."

D,E Cultural imposition is imposing our own cultural norms onto those from another cultural group. By obtaining an interpreter for Mr. Tran, the nurse is promoting culturally competent care, ensuring the patient can communicate his feelings and needs thoroughly to the staff. Patients do have a right to an interpreter, but stating that Mike is right is not promoting culturally competent care and is instead confirming his opinion. Asking family members to convince the patient to speak English is not promoting culturally competent care and also undermines the trust between nurse and patient. Instead of encouraging the patient to speak English, an interpreter should be obtained for the patient.

When assessing and planning treatment for a client who has recently arrived in the United States from China, the nurse should be alert to the possibility that the client's explanatory model for his illness reflects which cultural concept? A. Supernatural causes B. Negative forces C. Inheritance D. Yin-Yang

D. Yin-Yang Many Eastern cultures explain illness as a function of imbalance such as Yin-Yang. None of the other options are widely reflected in the Chinese culture.

Which response should the nurse provide a client who asks, "Why you need to conduct an assessment interview"? A."I need to find out more about you and the way you think in order to best help you." B. "The assessment interview lets you have an opportunity to express your feelings." C."You are able to tell me in detail about your past so that we can determine why you are experiencing mental health alterations." D."We will be able to form a relationship together where we can discuss the current problems and come up with goals and a plan for treatment."

D."We will be able to form a relationship together where we can discuss the current problems and come up with goals and a plan for treatment." Some of the purposes of the assessment interview are to establish rapport, learn more about the presenting issues, and form mutual goals and a plan for treatment. The other options do not appropriately explain the assessment purpose.

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? A.None, because no explicit threat has been made. B.Ask the client if he is threatening his wife. C.Call the client's wife and report the threat. D.Report the incident to the client's therapist.

D.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.

Which severe mental illness is recognized across cultures? (Select all that apply.) A. Antisocial disorder B. Schizophrenia C. Anorexia nervosa D. Social phobia E. Bipolar disorder F. Borderline personality disorder

E. Bipolar disorder Correct B. Schizophrenia Correct Worldwide studies indicate that both schizophrenia and bipolar disorder are recognized cross-culturally.

When providing respectful, appropriate nursing care, how should the nurse identify the patient and his or her observable characteristics? a. The manic patient in room 234 b. The patient in room 234 is a manic c. The patient in room 234 is possibly a manic d. The patient in room 234 is displaying manic behavior

d.