Module 1 (Unit C): Cultural Considerations and Therapeutic Communication

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.DIF: Cognitive Level: Analyze (Analysis)REF: pages 4, 5TOP: Nursing Process: ImplementationMSC: NCLEX: Psychosocial Integrity

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.DIF: Cognitive Level: Apply (Application)REF: pages 18, 19TOP: Nursing Process: ImplementationMSC: NCLEX: Psychosocial Integrity

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.REF: 70

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. The nurse's behavior in the nurse-client relationship 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.REF: 151

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.DIF: Cognitive Level: Apply (Application)REF: pages 17, 18TOP: Nursing Process: InterventionMSC: NCLEX: Psychosocial Integrity

A client states "That nurse never seems comfortable being with me." The nurse can be described as A. not seeming genuine to the client. B. transmitting fear of clients. C. unfriendly and aloof. D. controlling.

A. not seeming genuine to the client. Hiding behind a role, using stiff or formal interactions, and creating distance between self and client suggest a nurse is lacking in genuineness, or the ability to interact in a person-to-person fashion. This characteristic is not associated with the other options.REF: 126-127, 133

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. "School is stressful. What do you find most stressful?" 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.REF: 142

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.REF: 67-68

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.REF: 71

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.DIF: Cognitive Level: Analyze (Analysis)REF: page 12TOP: Nursing Process: DiagnosisMSC: NCLEX: Psychosocial Integrity

After a suicide attempt, Edgar tells the nurse, "I need my belt to keep my pants up. They keep falling down." Which response should the nurse provide? A. "Your belt is locked in the business office for safekeeping, along with all your other valuables." B. "For safety reasons, hospitalized clients are not allowed to keep certain personal possessions." C. "I cannot provide your belt, but I will help you get some pants with an elastic waistband." D. "I will ask the psychiatric technician to get your belt for you."

C Clients' rights allow them to keep personal possessions except those that might prove dangerous. A belt is potentially dangerous; so, the client should be prohibited from having it. It is important however for the nurse to respond to the client's need. Elastic banded pants are safe and the client would not need a belt. REF: 75

Which term refers to individuals' belief that their cultural values and practices are correct and superior to those of others? A. Assimilation B. Enculturation C. Ethnocentrism D. Somaticization

C Ethnocentrism is the universal tendency of humans to think that their way of thinking and behaving is the only correct and natural way.

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. A Chinese American client Chinese Americans may not like to be touched by strangers since it is a cultural characteristic.REF: 148

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

A, B, C, and E D. INCORRECT: Detoxification programs are services provided in a partial hospitalization program.

A nurse is communicating with a client who was just admitted for treatment of a substance use disorder. Which of the following communication techniques should the nurse identify as a barrier to therapeutic communication? A. Offering advice B. Reflecting C. Listening attentively D. Giving information

A. Offering advice A. Advice tends to interfere with the client's ability to make personal decisions and choices. B. Reflection encourages client to make choices. C. Skill of listening is important. D. Giving information informs client of needed facts. ATI RN Mental Health Nursing Modules Ch. 3 Application Exercises

A nurse is communicating with a client on the acute mental health facility. The client states, "I can't sleep. I stay up all night." The nurse responds, "You are having difficulty sleeping?" Which of the following therapeutic communication techniques is the nurse demonstrating? A. Offering general leads B. Summarizing C. Focusing D. Restating

D. Restating A. Takes direction. B. Enhances understanding. C. Concentrates attention to one single point. D. Restating allows the nurse to repeat the main idea expressed. ATI RN Mental Health Nursing Modules Ch. 3 Application Exercises

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 phase 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.REF: 132-133

As a nurse assesses a new client, the nurse makes sure the door remains open. Which type of communication factor is this action? A. Environmental B. Relationship C. Personal

A Environmental factors that may affect communication include physical factors (e.g., background noise, lack of privacy, uncomfortable accommodations) and societal determinants (e.g., sociopolitical, historical, and economic factors, the presence of others, expectations of others).

A nurse spends extra time with a client who has personality features similar to the nurse's estranged spouse. Which aspect of countertransference is most likely to result? A. Overinvolvement B. Misuse of honesty C. Indifference D. Rescue

A Overinvolvement is a reaction to countertransference. It is important for the nurse to establish firm treatment boundaries, goals, and nursing expectations.

Which term on an assessment form is broader? A. Spirituality B. Religion C. Church/mosque/temple/synagogue D. None of the above.

A Spirituality addresses universal human questions and needs. Spirituality is cognitive, experiential, and behavioral. In contrast, religion is an external system that includes beliefs, patterns of worship, and symbols. Although religion is often concerned with spirituality, religious groups are social entities and are often characterized by other nonspiritual goals (cultural, economic, political, social). REF: 122

As Becky is preparing for discharge, she presents you with a handmade card of appreciation for the care you provided. Should you accept the card? A. Yes B. No C. Depends on state laws D. Depends on her illness

A The meaning of the gift needs to be examined. If a gift is inexpensive and given at the end of hospitalization when a relationship has developed, the nurse should graciously accept.

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.REF: 64

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.REF: 116

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.REF: 71

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. Germany Eye contact conveys interest to most northern European individuals. Eye contact would be considered intrusive to the others.REF: Page 147-148

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.REF: 90

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.REF: 115

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.REF: 65-66

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.REF: 80

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. The nurse violated the client's personal space by physically being too close. 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.DIF: Cognitive Level: Analyze (Analysis)REF: page 34TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity

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. The response may reflect cultural norms. 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.DIF: Cognitive Level: Analyze (Analysis)REF: page 9TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity

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

B: For clients who are noncompliant with traditional therapy. ATI RN Mental Health Nursing Modules Ch. 6 Application Exercises

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

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

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. Nonverbal and verbal communication may be different; nurses must pay attention to the nonverbal communication being presented to get an accurate message. 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.DIF: Cognitive Level: Analyze (Analysis)REF: pages 7-9TOP: Nursing Process: PlanningMSC: NCLEX: Psychosocial Integrity

A nurse is caring for a client who has anorexia nervosa. Which of the following examples demonstrates the nurse's use of interpersonal communication? A. the nurse discusses the client's weight loss during a health care team meeting. B. The nurse examines her own personal feelings about clients who have anorexia nervosa. C. The nurse asks the client about her body image perception. D. The nurse presents an educational session about anorexia nervosa to a large group of adolescents.

C. The nurse asks the client about her body image perception. The nurse's one-on-one communication with the client is an example of interpersonal communication.

A nurse is conducting therapy with several clients and their families. Effective communication with clients and families is based on: A. discussing in-depth topics with which the client feels comfortable. B. using silence to avoid unpleasant or difficult topics. C. attending to verbal and nonverbal behaviors. D. requiring the client and family to ask for feedback.

C. attending to verbal and nonverbal behaviors. A. Often, very brief conversations are most effective. B. Silence is to allow the client time for reflection or to convey nonverbal support. C. Attending to verbal and nonverbal behaviors is necessary for effective communication. D. Not an effective technique. ATI RN Mental Health Nursing Modules Ch. 3 Application Exercises

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

C: Client is at greatest risk for self-harm. Others have needs, but not as high priority. ATI RN Mental Health Nursing Modules Ch. 6 Application Exercises

A nurse is working on promotion of healthy coping skills with older adult clients who had all previously been hospitalized for severe depression and are now in a residential care facility. The nurse should recognize that this is an example of which of the following? A. Primary prevention B. Secondary prevention C. Tertiary prevention D. Mental status examination

C: Tertiary prevention Primary: preventing initial onset of a mental health problem. Secondary: early detection of disease. Tertiary: Prevention of further problems in clients already diagnosed with mental illness. Mental Status Examination: Not type of prevention. ATI RN Mental Health Nursing Modules Ch. 6 Application Exercises

When a family asks a nurse for reassurance about a client's condition, which of the following is an appropriate response? A. "I think your son is getting better. What have you noticed?" B. "I'm sure everything will be okay. It just takes time to heal." C. "I'm not sure what's wrong. Have you asked the doctor about your concerns?" D. "I understand you're concerned. Let's discuss what concerns you specifically."

D. "I understand you're concerned. Let's discuss what concerns you specifically." A, B, C: Interjects nurse's opinion, causing family to withhold their thoughts and feelings. D. A therapeutic response reflects upon, and accepts, the family's feelings, and it allows the members to clarify what they are feeling. ATI RN Mental Health Nursing Modules Ch. 3 Application Exercises

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. "It looks as though you are saying one thing but feeling another. Can you tell me what may be upsetting you?" 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.DIF: Cognitive Level: Analyze (Analysis)REF: pages 7-9TOP: Nursing Process: ImplementationMSC: NCLEX: Psychosocial Integrity

A charge nurse is conducting a class on therapeutic communication to a group of newly licensed nurses. Which of the following responses by the newly licensed nurse requires additional teaching regarding nonverbal communication? A. Personal space B. Posture C. Eye contact D. Intonation

D. Intonation Personal space, posture, and eye contact is a part of nonverbal behavior. Intonation is the tone of one's voice and can communicate a variety of feelings. ATI RN Mental Health Nursing Modules Ch. 3 Application Exercises

Which most accurately describes a patient-centered medical home? A. All levels of mental and physical care are addressed by a team that coordinates with the broader health system. B. Emergency services, community and/or home-based services, and outpatient services across the life span are provided. C. The patient received psychiatric services in the home. D. A multidisciplinary team works intensively with patients in their homes, or in agencies, hospitals, or clinics—whatever settings patients find themselves in.

A A patient-centered medical home provides access to physical health, behavioral health, and supportive community and social services through a multidisciplinary team that coordinates with the broader health system. It is considered patient-centered because the patient is a core member of the team and care takes into account the unique needs of the whole person. Community mental health systems provide emergency services, community and/or home-based services, and outpatient services across the lifespan (B). Psychiatric home care provides services in the home (C) to individuals with a qualifying "homebound" status. Finally, it is the assertive community treatment (ACT) team that works intensively with patients in their homes, or in agencies, hospitals, or clinics—whatever settings patients find themselves in (D).

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

A, B, C, E (not D) 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.REF: 116-117

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 (not C) 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.REF: 125

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.REF: 86-87

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.REF: 78

The nurse is finding it difficult to provide structure and set limits for a client. The nurse should self-evaluate for which characteristic of a dysfunctional nurse-patient relationship? A. Boundary blurring B. Value dissonance C. Covert anger D. Empathy

A. Boundary blurring Boundary blurring is often signaled by the nurse being either too helpful or not helpful enough. The behavior is not associated with any of the other options.REF: 127

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

A. Break-away closet bars to prevent hanging Hangings are the most common method of inpatient suicide. The other options are important safety measures but don't directly address the suicide method of hanging.DIF: Cognitive Level: Apply (Application)REF: page 26TOP: Nursing Process: PlanningMSC: NCLEX: Physiological Integrity

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.REF: 80

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.REF: 65-66

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.REF: 79-80

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.REF: 69-70

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.REF: 116-117

Becky tells you, "I have something secret to tell you, but you can't tell anyone else." The nurse agrees. What is the likely consequence of the nurse's action? A. Healthy feelings of sympathy by the nurse toward the client. B. Blurred boundaries in the nurse-client relationship. C. Improved rapport between the nurse and client. D. Enhanced trust between the nurse and client.

B Keeping secrets indicates that the nurse is overly involved and is one aspect of blurred boundaries.

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.REF: 85-86

You discover that part of Mr. R's lack of appetite has been due to a urinary tract infection he has been unable to articulate. You ask his sister for more information about the home environment, ADLs, and medications. What type of information source is his sister? A. Primary B. Secondary C. Private D. Informed

B Secondary sources are valuable when caring for a client experiencing psychosis, muteness, agitation, or catatonia. Such secondary sources include members of the family, friends, neighbors, police, health care workers, and medical records.

After your first conversation, Becky withdraws from you again before you've even really begun. Which statement will contribute most to establishing Becky's trust? A. "Weren't you complying with your medication regimen?" B. "It must be discouraging to be readmitted to the hospital so soon." C. "Everyone with bipolar disorder ends up in the hospital occasionally." D. "You must take your drugs as prescribed or you will be rehospitalized."

B When the nurse shows genuine concern for another's circumstances (has positive regard and empathy), even a short encounter can have a powerful effect.

Although his daughter has been here almost 15 years, Mr. H is a fairly new immigrant. He speaks some English and is highly educated. Although you've had no time to ask many questions, he is clearly of a more Eastern tradition. Which attitude would you expect him to share? A. "Disease is caused by fluctuations in opposing forces." B. "Disease is part of one's fate and we have a duty to comply." D. "Disease has a cause, and treatment is aimed at the cause."

B Eastern tradition and some western collective cultures see the family as the basis for one's identity, so that family interdependence and group decision making are the norm. The body, mind, and spirit are considered a single entity. Therefore, there is no sense of separation between a physical illness and a psychological one. One is born into an unchangeable fate, with which one has a duty to comply.

Which worldview would the nurse anticipate from a client who says, "It is important to save enough money to take care of yourself in your old age. We should not rely on anyone else to take care of us." A. Eastern (balance) B. Western (science) C. Indigenous (harmony)

B In the Western tradition, one's identity is found in one's individuality, which inspires the valuing of autonomy, independence, and self-reliance. Success in life is obtained by preparing for the future.

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.REF: 68-69

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. "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!" 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.DIF: Cognitive Level: Analyze (Analysis)REF: pages 11, 12TOP: Nursing Process: EvaluationMSC: NCLEX: Psychosocial Integrity

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.REF: 87

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.DIF: Cognitive Level: Analyze (Analysis)REF: page 14TOP: Nursing Process: PlanningMSC: NCLEX: Safe and Effective Care Environment

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.DIF: Cognitive Level: Apply (Application)REF: page 5TOP: Nursing Process: PlanningMSC: NCLEX: Psychosocial Integrity

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.DIF: Cognitive Level: Apply (Application)REF: page 10TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity

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.REF: 66-67

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. Orientation 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.REF: 130-131

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.REF: 115

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.REF: 71

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.DIF: Cognitive Level: Apply (Application)REF: page 6TOP: Nursing Process: Outcome IdentificationMSC: NCLEX: Psychosocial Integrity

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. The nurse and client sitting at a 90-degree angle to each other. 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.REF: 150

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. Therapeutic encounter A therapeutic encounter is a short but helpful interaction between the nurse and client. None of the other options reflect this form of relationship.REF: 126-127

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. Using an open-ended question 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.REF: 143

Which behavior from Noah would be considered a double-bind message? A. He winks at you and says, "Do you date 15-year-old guys?" B. He puts his head in his hands, shakes it, and snaps, "I don't want to do this. Just get me out of here!" C. He sneers at you and almost purrs as he says, "Oh yes. I will tell you anything you want to know. Of course. Of course I will." D. He cries and shakes, jiggling one leg, as he says softly, "Please. Let's just not talk about Dad, okay? God, please?"

C A double-bind message is a mutually contradictory message given by a person in power or attempting to gain or maintain power. In example C, Noah is in a frightening or uncomfortable position and attempts to gain or maintain some control or power. You, the nurse, want information from him. You want his cooperation, and he doesn't want to give it. So his nonverbal language—sneering and a rather mocking purr—contradicts the verbal message, or content: that of a promise to cooperate and answer "anything." In examples B and D, his actions match his verbal message. They do in "A" as well. He is trying to deflect you from the serious nature of the interview, but he's not using a double-bind message. His wink does match his words.

You are about to initiate your first contact with Becky. Which is the most suitable goal in establishing the therapeutic relationship? A. Establish friendship and a sense of fun B. Ensure that mutual needs will be met C. Establish clear boundaries while identifying patient needs D. Ensure two-way communication to give or ask for help

C A therapeutic relationship demonstrates the following qualities: Needs of patient identified and explored Clear boundaries established Problem-solving approaches taken New coping skills developed Behavioral change encouraged The other choices listed here are more appropriate to a social relationship.

Which type of prevention is Edgar's team most focused on? A. Primary prevention B. Secondary prevention C. Tertiary prevention D. It's too late for prevention; Edgar already has a depressive disorder.

C Tertiary prevention is the treatment of disease with a focus on preventing the progression to a severe course, disability, or even death. In the case of treating major depression, the aim is to avoid loss of employment, reduce disruption of family processes, and prevent suicide. Primary prevention (A) occurs before any problem is manifested and seeks to reduce the incidence, or rate of new cases. Secondary prevention (B) is also 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. Finally, just because a patient is diagnosed with major depression, or any significant chronic disease, this does not mean that prevention is a moot point (D).

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. DIF: Cognitive Level: Apply (Application)REF: page 7TOP: Nursing Process: ImplementationMSC: NCLEX: Safe and Effective Care Environment

Which statement made by the nurse would acknowledge that they understand the difference between the ethnicity and culture? 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 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 culture refers to sharing the same beliefs and values." Ethnicity is sharing a common history and heritage. Culture comprises the shared beliefs, values, and practices that guide a group's members in patterned ways of thinking and acting. The other options are all incorrect definitions of either ethnicity and/or culture.DIF: Cognitive Level: Analyze (Analysis)REF: page 3TOP: Nursing Process: EvaluationMSC: NCLEX: Psychosocial Integrity

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. "That must have been such a hard situation for you to deal with." 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.DIF: Cognitive Level: Analyze (Analysis)REF: pages 22, 23TOP: Nursing Process: ImplementationMSC: NCLEX: Psychosocial Integrity

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.REF: 87-88

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.DIF: Cognitive Level: Apply (Application)REF: page 6TOP: Nursing Process: AssessmentMSC: NCLEX: Safe and Effective Care Environment

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.DIF: Cognitive Level: Analyze (Analysis)REF: page 74TOP: Nursing Process: AssessmentMSC: NCLEX: Safe and Effective Care Environment

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. A quiet section of the day room 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.REF: 140-149

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.

C. 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.REF: 111

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.DIF: Cognitive Level: Apply (Application)REF: page 15TOP: Nursing Process: Outcome IdentificationMSC: NCLEX: Psychosocial Integrity

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.REF:111-112

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

C. Authentic 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.REF: 133

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.REF: 87-88

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.REF: 112

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.REF: 68-69

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.REF: 67

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. They view the nurse as a stranger. 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.REF: Page 151

What is the primary difference between a social and a therapeutic relationship? A. Type of information exchanged B. Amount of satisfaction felt C. Type of responsibility involved D. Amount of emotion invested

C. Type of responsibility involved In a therapeutic relationship the nurse assumes responsibility for focusing the relationship on the client's needs, facilitating communication, assisting the client with problem-solving, and helping the client identify and test alternative coping strategies.REF: 127-128

As Mr. R's sister has suspected, Mr. S sometimes forgets to eat. In which part of the nursing care plan would the nurse expect to find this statement: "Offer snacks and finger foods frequently." A. Assessment B. Diagnosis C. Planning and outcomes identification D. Intervention E. Evaluation

D Psychiatric mental health nursing practice includes four basic-level interventions: coordination of care, health teaching and health promotion, milieu therapy, and pharmacological, biological, and integrative therapies. Encouraging Mr. R to eat small snacks involves both health teaching (for his caregivers) and health promotion (helping Mr. R. recovery better nutritional habits).

Noah has made it clear he doesn't want to talk about his dad. But the truth is, as the interview proceeds, he becomes anxious and tries to evade all questions about why he is here. Which type of communication might be most appropriate right now? A. Stop questioning so much and just give him some good advice so he'll trust you. B. Express honest disapproval of his resistance to help. C. Ask him pointblank why he is evading you. D. Ask a miracle question.

D The miracle question is a goal-setting question that helps patients to see what the future would look like if a particular problem were to vanish. While Noah is anxious about saying anything specific about what is troubling him, he may be able to talk about what he might wish for. This very basic question often gets to the source of the most important issues in a person's thinking and life. The other three solutions here are all excellent examples on nontherapeutic communication techniques.

You notice that you look forward to talking to Becky because her dark sense of humor reminds you of your best friend in high school. You also begin to make little cynical jokes, hoping to have a good laugh together. What is this relationship showing early signs of? A. Accountability B. Self-reflection C. Transference D. Countertransference

D Countertransference occurs when the nurse unconsciously displaces feelings related to significant figures in the nurse's past onto the patient.

Noah's whispered statement of "Yeah, well. It's just gonna keep on happening" does not involve which of the following? A. Channel B. Stimulus C. Message D. Feedback

D Feedback is provided by the person receiving Noah's message, after interpreting and responding. This is what the nurse will do in response to Noah's statement, which implies a desire to be understood and perhaps helped. Noah is the sender and the stimulus (B) here is his need to communicate with another for information, comfort, or advice. He sends his message (C) through an auditory channel—a whispered statement meant only for the nurse to hear.

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 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 "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." "What you are saying is actually considered cultural imposition, which is imposing our own culture onto someone from a different culture." 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.DIF: Cognitive Level: Apply (Application)REF: page 21TOP: Nursing Process: Outcome IdentificationMSC: NCLEX: Psychosocial Integrity

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. "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." 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.DIF: Cognitive Level: Analyze (Analysis)REF: page 18TOP: Nursing Process: ImplementationMSC: NCLEX: Psychosocial Integrity

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.DIF: Cognitive Level: Analyze (Analysis)REF: page 9TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity

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.REF: 113-114

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.REF: 67

The outcome of the nurse's expressions of sympathy instead of empathy toward the client often leads to which outcome? A. Enhanced client coping B. Lessening of client emotional pain C. Increased hope for client improvement D. Decreased client communication

D. Decreased client communication Sympathy and the resulting projection of the nurse's feelings limit the client's opportunity to further discuss the problem. The remaining options are positive outcomes.REF: 133

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. "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." 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.DIF: Cognitive Level: Analyze (Analysis)REF: pages 25 TOP: Nursing Process: ImplementationMSC: NCLEX: Psychosocial Integrity

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.DIF: Cognitive Level: Analyze (Analysis)REF: pages 12, 13TOP: Nursing Process: Outcome IdentificationMSC: NCLEX: Safe and Effective Care Environment

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. Allow the client to break the silence. 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.REF: 141-142

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. Asking open-ended questions and seeking clarification 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.REF: 142-143

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 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.REF: 142

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. Clarifying the message 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.REF: 142

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. Content of messages may be contradicted by process. 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.REF: 140-141

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.REF: 64

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.REF: 116

A client tells the nurse "I really feel close to you. You are like the friend I never had." The nurse can assess this statement as indicating the client may be experiencing which unconscious emotion? A. Congruence B. Empathetic feelings C. Countertransference D. Positive transference

D. Positive transference Transference involves the client experiencing feelings toward a nurse that belong to a significant person in the client's past. If a patient is motivated to work with you, completes assignments between sessions, and shares feelings openly, it is likely the patient is experiencing positive transference. The behavior is not associated with any of the other options.REF: 127-128

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 and exploring 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.REF: 142

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.REF: 69-70

You teach Mr. R's sister about important precautions associated with a new prescription. Afterward, she accurately summarizes major self-management strategies associated with this drug. Which step of the nursing process applies to her summarization? A. Assessment B. Analysis C. Planning/outcomes identification D. Intervention E. Evaluation

E Evaluation of the individual's response to treatment should be systematic, ongoing, and criteria based. Supporting data are included to clarify the evaluation—including ability to accurately relay treatment instructions and precautions.