N144 - Unit 1
A student nurse exhibits the following behaviors or actions while interacting with her patient. Which of these are appropriate as part of a therapeutic relationship? a. Sitting attentively in silence with a withdrawn patient until the patient chooses to speak. b. Offering the patient advice on how he could cope more effectively with stress. c. Controlling the pace of the relationship by selecting topics for each interaction. d. Limiting the discussion of termination issues so as not to sadden the patient unduly.
A
Amanda was raised by a rejecting and abusive father and had a difficult childhood. As an inpatient, she frequently comments on how hard her nurse, Jane, works and on how other staff members do not seem to care as much about their patients as Jane does. Jane finds herself agreeing with Amanda. Jane appreciates her insightfulness, and realizes that the other staff members do not appreciate how hard she works and take her for granted. Jane enjoys the time she spends with Amanda and seeks out opportunities to interact with her. What phenomenon is occurring here, and which response by Jane would most benefit her and the patient? a. Amanda is experiencing transference; Jane should help Amanda to understand that she is emphasizing in Jane those qualities that were missing in her father. b. Jane is idealizing Amanda, seeing in her strengths and abilities that Amanda does not possess; Jane should temporarily distance herself somewhat from Amanda. c. Amanda is overidentifying with Jane, seeing similarities that do not in reality exist; Jane should label and explore this phenomenon in her interactions with Amanda. d. Jane is experiencing countertransference in response to Amanda's meeting Jane's needs for greater appreciation; Jane should seek clinical supervision to explore these dynamics.
A
Which of the following actions best represents the basis or foundation of all other psychiatric nursing care? a. The nurse assesses the patient at regular intervals. b. The nurse administers psychotropic medications. c. The nurse spends time sitting with a withdrawn patient. d. The nurse participates in team meetings with other professionals.
A
When interviewing an adolescent client, the nurse can expect the client to be most concerned about the issue of a. confidentiality. b. sexual orientation. c. substance use or abuse. d. family mental problems.
A Adolescents are often concerned that what they reveal to the nurse or health care team will be shared with parents. Confidentiality should be explained at the outset of the interview.
High levels of anxiety and maladaptive behavior are seen a. in all areas in the health care setting. b. only in the psychiatric mental health setting. c. where death is a frequent outcome despite treatment. d. when the nurse and client have yet to establish a therapeutic relationship.
A Anxiety occurs whenever individuals are faced with unfamiliar circumstances or other threats to the self. The health care setting presents many possible threats to the self, such as illness, disability, surgery, and pain.
What is the common behavior shared by both client and nurse at the beginning of the initial assessment interview? a. Anxiety b. Biased perceptions c. Countertransference d. Reliance on supportive confrontation
A Both parties feel at least a small amount of anxiety associated with interacting with an unknown person.
The nurse is finding it difficult to provide structure and set limits for a client. The nurse should self-evaluate for a. boundary blurring. b. value dissonance. c. covert anger. d. empathy.
A Boundary blurring is often signaled by the nurse being either too helpful or not helpful enough.
One of the possible sources of boundary violations is placing the focus on a. meeting the nurse's needs. b. identifying client disturbances. c. assessing the client's ego strength. d. assessing the client's weaknesses.
A Boundary violations have two sources: (1) allowing the therapeutic relationship to slip into a social relationship, and (2) meeting the nurse's personal needs at the expense of the client's needs.
You are caring for Kiley, a 29-year-old female patient who is being admitted following a suicide attempt. Which of the following illustrates the concept of patient advocacy? a. "Dr. Raye, I notice you ordered Prozac for Kiley. She has stated to me that she does not want to take Prozac because she had adverse effects when it was previously prescribed." b. "Dr. Raye, during her admissions interview Kiley stated that she has had three other suicide attempts in the past." c. "Kiley, can you tell me more about your depression and your suicide attempt?" d. "Kiley, I will take you on a tour of the unit and orient you to the rules."
A 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.
The pre-orientation phase of the nurse-client relationship is characterized by the nurse's focus on a. self-analysis of strengths, limitations, and feelings. b. clarification of the nursing role. c. changing the client's dysfunctional behavior. d. incorporating coping skills into client's routine.
A During the preorientation phase the nurse prepares for a relationship with a client by engaging in self-examination.
An action that is acceptable in a social relationship but not in a therapeutic relationship is a. giving advice. b. listening actively. c. clarifying feelings. d. giving positive regard.
A Giving and receiving advice is acceptable in a social relationship. In a therapeutic relationship, it is appropriate for the nurse to assist the client in exploring alternative solutions to problems and in making his or her own decisions.
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 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.
The nurse planning care for a mentally ill client bases interventions on the concept that the client a. has areas of strength on which to build. b. has right that must be respected. c. comes with experiences that contribute to their problem. d. share fears that are similar to those of all mentally healthy individuals.
A 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.
To help a client develop his or her resources, the nurse must first be aware of a. the client's strengths. b. negative transferences. c. countertransferences. d. resistances.
A Nurses work to bolster a client's strengths, to identify areas of dysfunction, and to assist in the development of new coping strategies.
The client's priority nursing diagnosis has been established as risk for self-directed violence: suicide related to multiple losses. The priority outcome would be that the client will 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 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.
Which statement best describes the 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 The DSM-5 is a classification of mental disorders that includes descriptions and criteria of diagnoses.
According to the DSM-5, there is evidence that symptoms and causes of mental illness are influenced by: a. cultural and ethnic factors. b. occupation and status. c. birth order. d. sexual preference.
A The DSM-5 states there is evidence to suggest that mental illness is influenced by cultural and ethnic factors. The DSM-5 does not state that there is evidence that occupation, birth order, or sexual preference affect mental illness.
Current information suggests that the most disabling mental disorders are the result of a. biological influences. b. psychological trauma. c. learned ways of behaving. d. faulty patterns of early nurturance.
A 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.
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 The client should always be considered the primary data source. At times, however, the client will be unable to fulfill this role.
The use of empathy and support begins in the stage of the nurse-client relationship termed the a. orientation stage. b. working stage. c. identification stage. d. resolution stage.
A The use of empathy and support should begin in the orientation stage. These tools are helpful in building trust and furthering the relationship.
A 14-year-old belongs to a neighborhood gang, engages in sexually promiscuous behavior, and has a history of school truancy but reports that her parents are just old- fashioned and don't understand her. The assessment data supports that the client a. is displaying deviant behavior. b. cannot accurately appraise reality. c. is seriously and persistently mentally ill. should be considered for group home placement.
A This client is demonstrating deviant behavior. This client demonstrates undersocialized, aggressive behavior such as a repetitive and persistent pattern of aggressive conduct in which the basic rights of others are violated.
The principle that is the basis of nursing outcome planning is a. individuals have the right to autonomy to make decisions that affect them. 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 This is the only true statement. The nurse and the client should work collaboratively because each has knowledge to contribute to planning for the attainment of mutually derived outcomes.
Interviewer anxiety during an assessment interview is most likely to be a result of a. the client's perception of the interviewer's ability to help. b. concern resulting from the need to form a relationship. c. the nurse's inability to decide on a plan of action. d. the cultural biases of both the client and the nurse.
A Whenever a client is in doubt about the helpfulness of the interviewer, anxiety is generated. The interviewer can "tune in" to the client's anxiety by empathy.
The most likely factor to interfere with data collection in an initial assessment interview of an older adult is a. whether the client has any physical deficiencies. b. the interviewing nurse's level of anxiety. c. the presence of any countertransference. d. the nurse's attitudes about aging.
A While all the options can interfere, the most prevalent one affecting the data collected is any physical and/or cognitive deficiencies that client may possess.
Which are the purposes of a thorough mental health nursing assessment? Select all that apply. a. Establish a rapport between the nurse and patient. b. Assess for risk factors affecting the safety of the patient or others. c. Allow the nurse the chance to provide counseling to the patient. d. Identify the nurse's goals for treatment. e. Formulate a plan of care.
A, B, D, E
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. 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.
A 43-year-old female patient is brought to the emergency department with complaints of bizarre speech, visual hallucinations, and changes in behavior. She has no psychiatric history. Before ordering a psychiatric consultation, the emergency room physician orders a battery of blood tests as well as an MRI of the brain. The rationale for this is: a. To avoid a lawsuit. b. Medical conditions and physical illnesses may mimic psychiatric illnesses; therefore, physical causes of symptoms must be ruled out c. Emergency room physicians are required to order a certain number of tests for the emergency room visit to be reimbursed. d. To comply with hospital standards of care.
B
A male patient frequently inquires about the female student nurse's boyfriend, social activities, and school experiences. Which of the following initial responses by the student best addresses the issue raised by this behavior? a. The student requests assignment to a patient of the same gender as the student. b. She limits sharing personal information and stresses the patient-centered focus of the conversation. c. She tells him that she will not talk about her personal life. d. She explains that if he persists in focusing on her, she cannot work with him.
B
The intervention that can be practiced by an advanced practice registered nurse in psychiatric mental health but cannot be practiced by a basic level registered nurse is: a. Advocacy b. Psychotherapy c. Coordination of care d. Community-based care
B
You are performing a spiritual assessment on a patient. Which patient statement would indicate that there is an experiential concern in the patient's spiritual life? a. "I really believe that my spouse loves me." b. "My sister will never forgive me for what I did." c. "I try to find time every day to pray, even though it's not easy." d. "I am happy with my life choices, even if my mother is not."
B
When a nurse and client meet informally or have an otherwise limited but helpful relationship, the relationship is referred to as a(n) 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.
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.
Which statement about diagnosis of a mental disorder is true? a. The symptoms of each disorder are common among all cultures. b. Culture may cause variations in symptoms for each clinical disorder. c. All mental disorders listed in the DSM-5 are seen in all other cultures. d. Psychiatric diagnoses are listed in separately from other physical disorders in a five axes system.
B Every society has its own view of health and illness and the types of behavior categorized as mental illness. Culture also influences the symptoms of a particular disorder. For example, individuals of certain cultures are more likely to express depression through somatic symptoms than through affect and feeling tone. The five axes system was abandoned in this edition of the DSM-5.
During the initial assessment interview with a psychiatric client, the nurse should regard the spiritual assessment as a. optional. b. important to complete. c. less relevant than the cultural assessment. d. relevant only when the client is oriented.
B For many clients, religious or spiritual practices are an important part of the quality of their lives. Nurses should support the spiritual dimension of the person. To do so, assessment is necessary.
Joel is a 43-year-old patient being seen in the mental health clinic with depression. Joel 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 Joel's comment? a. Ineffective coping b. Spiritual distress c. Risk for self-harm d. Hopelessness
B Joel is expressing distress regarding his religion and spiritual well-being. Joel could be experiencing ineffective coping, but this does not directly relate to his comment. There is nothing in Joel's comment that would lead to the conclusion the patient is having thoughts of harming himself. Joel's comment does not describe hopelessness.
These severe mental illnesses are recognized across cultures: a. antisocial and borderline personality disorders. b. schizophrenia and bipolar disorder. c. bulimia and anorexia nervosa. d. amok and social phobia.
B Worldwide studies indicate that both schizophrenia and bipolar disorder are recognized cross-culturally.
A nurse who is active in local consumer mental health groups and in local and state mental health associations and who keeps aware of state and national legislation affecting mental illness treatment may positively affect the climate for treatment by: a. becoming active in politics leading to a potential political career. b. reducing the stigma of mental illness and advocating for equality in treatment. c. encouraging 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 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.
In order to best differentiate whether an Asian client is demonstrating a mental illness when attempting suicide is to a. ask the client whether he views himself as being depressed. b. identify his culture's view regarding suicide. c. explain to him that suicide is often regarded as a desperate act. d. assess the client for other examples of depressive behaviors.
B 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, and Middle Eastern "suicide bombers" are considered holy warriors or martyrs. Contrast these viewpoints with Western culture, where people who attempt or complete suicides are nearly always considered mentally ill.
One characteristic of mental health that allows people to adapt to tragedies, trauma, and loss is: a. dependence. b. resilience. c. pessimism. d. altruism.
B Resilience is a characteristic that helps individuals cope with loss and trauma that may occur in life. Dependence is described as being dependent 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.
In psychiatric nursing, assessment of a "client" refers exclusively to a. an individual with a psychiatric diagnosis. b. an individual, family, group, or community. c. any person who seeks the assistance of the psychiatric nurse. d. the person identified by the system as being in need of treatment.
B Standards of practice for psychiatric nursing indicate that the client can be an individual, a family, a group, or a community.
A client tells the mental health nurse "I am terribly frightened! I hear whispering that someone is going to kill me." Which criterion of mental health can the nurse assess as lacking? a. Control over behavior b. Appraisal of reality c. Effectiveness in work d. Healthy self-concept
B The appraisal of reality is lacking for this client. The client does not have a picture of what is happening around himself or herself.
You are conducting an admission interview with Callie, who was raped 2 weeks ago. When you ask Callie about the rape, she becomes very anxious and upset and begins to sob. Your best course of actions would be to: a. push Callie gently for more information about the rape because you need to document this in her chart. b. acknowledge that the topic of the rape is upsetting to Callie and reassure her that it can be discussed at another time when she feels more comfortable. c. use silence as a therapeutic tool and wait until Callie is done sobbing to continue discussing the rape. d. reassure Callie that anything she says to you will remain confidential.
B 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.
What three structural components comprise a nursing diagnosis? a. Problem, outcome, intervention b. Problem, etiology, supporting data c. Unmet need, goal, outcome criterion d. Presenting symptom, treatment, goal
B The components of the nursing diagnosis are problem, etiology, and supporting data.
The orientation phase of the nurse-client relationship focuses on a. the nurse identifying personal biases. b. the nurse and client identifying client needs. c. overcoming resistance to changing behavior. d. reviewing situations that occurred in previous meetings.
B The orientation phase is the first stage of the nurse-client relationship and focuses on, among other things, the identification of client needs.
Client reactions of intense hostility or feelings of strong affection toward the nurse are common forms of a. resistance. b. transference. c. countertransference. d. emotional abreaction.
B The stirring up of feelings in the client by the nurse is referred to as transference.
Bethany, a nurse on the psychiatric unit, has a past history of alcoholism. She has weekly clinical supervision meetings with her mentor, the director of the unit. Which statement by Bethany to her mentor would indicate the presence of countertransference? a. "My patient, Miranda, 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, Laney, 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, Jack, started drinking after 14 years of sobriety. We are focusing on his treatment plan of attending AA meetings five times a week after discharge." d. "My patient, Gayle, 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; Bethany may be overidentifying with the patient because of her own past history of alcoholism. She is providing adamant advice to the patient that, besides being nontherapeutic, may be more relevant to her own past 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.
Emily is a 28-year-old nurse on the psychiatric unit. She has been working with Jenna, a 27-year-old who was admitted with depression. Emily and Jenna find they have much in common, including each having a 2-year-old daughter and each having graduated from the same high school. Emily and Jenna discuss getting together for lunch with their daughters after Jenna is discharged. This situation reflects: a. Successful termination b. Promoting interdependence c. Boundary blurring d. A strong therapeutic relationship
C
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 who in the general population will develop a specific disorder. d. Identifying which individuals will respond favorably to a specific treatment.
C
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 individual 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
Which statement best describes a major difference between a DSM-5 diagnosis and a nursing diagnosis? a. There is no functional difference between the two; both serve to identify a human deviance. b. The DSM-5 diagnosis disregards culture, whereas the nursing diagnosis takes culture into account. c. The DSM-5 is associated with present symptoms, whereas a nursing diagnosis considers past, present, and potential responses to actual mental health problems. d. The DSM-5 diagnosis impacts the choice of medical treatment, whereas the nursing diagnosis offers a framework for identifying multidisciplinary interventions.
C
A nurse is about to interview a client whose glasses and hearing aid were placed in safe-keeping when she was admitted. Before beginning the interview, the nursing intervention that will best facilitate data collection is to 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 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.
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?" The nurse responds best by answering: 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 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.
The nurse would NOT address which of the following goals in attempting to establish a therapeutic nurse-client relationship? a. Assisting the client with self-care needs when appropriate. b. Helping the client identify self-defeating behaviors. c. Providing the client with opportunities to socialize. d. Facilitating the client's communication of disturbing feelings or thoughts. e. Encouraging the client to make decisions when appropriate.
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.
You are interviewing Jamie, a 17-year-old female patient. She confides that she has been thinking of ways to kill a female peer who is Jamie's rival for the volleyball team captain position. She asks you if you can keep it a secret. The most appropriate response for you to make is: 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. "Jamie, issues of this kind have to be shared with the treatment team and your parents." d. "Jamie, I will have to share this with the treatment team, but we will not share it with your parents."
C 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. This information would be shared with both the team and the parents.
You have graduated with your BSN degree and have taken your first job on a psychiatric unit after becoming a licensed Registered Nurse. You are providing teaching to Mason, a newly admitted patient on the psychiatric unit, regarding his daily schedule. Which of the following would not be an appropriate teaching statement? 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." d. "You will see your provider daily in a one-to-one session."
C Basic level RNs cannot perform psychotherapy. The other options are all appropriate expectations of a patient's schedule on a psychiatric unit.
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 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.
A client reports that her mother-in-law is very intrusive. The nurse responds, "I know how you feel. My mother-in-law is nosy, too." The nurse is demonstrating a. self-disclosure in an appropriate way. b. to the client permission to continue. c. countertransference. d. empathy to establish trust.
C Countertransference refers to the stirring up of feelings in the nurse by the client.
The quantitative study of the distribution of mental disorders in human populations is called a. mortality. b. prevalence. c. epidemiology. d. clinical epidemiology.
C 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.
According to Rogers, a synonym for genuineness is a. respect. b. empathy. c. congruence. d. positive regard.
C Genuineness refers to self-awareness of one's feelings as they arise within the relationship and the ability to communicate them when appropriate. It is the ability to meet others person-to-person without hiding behind roles. Rogers uses the word congruence to signify genuineness.
The primary difference between a social and a therapeutic relationship is the a. type of information exchanged. b. amount of satisfaction felt. c. type of responsibility involved. d. amount of emotion invested.
C 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.
The mental health status of a particular client can best be assessed by considering a. the degree of conformity of the individual to society's norms. b. the degree to which an individual is logical and rational. c. placement on a continuum from health to illness. d. the rate of intellectual and emotional growth.
C 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.
A nursing diagnosis for a client with a psychiatric disorder serves the purpose of a. justifying the use of certain psychotropic medication. b. providing data essential for insurance reimbursement. c. providing a framework for selecting appropriate interventions. d. completing the medical diagnostic statement.
C Nursing diagnoses provide the framework for identifying appropriate nursing interventions for dealing with the phenomena a client with a mental health disorder is experiencing.
Which of the following best 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 medical/surgical coverage. d. A client who has attempted suicide is hospitalized for a mental health evaluation.
C 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.
You are working in the emergency department when a 26-year-old male patient is brought in suffering from psychosis. The patient is unable to give any coherent history. The patient's best friend is with him and offers to give you information regarding the patient. Which of the following responses is appropriate? 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 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.
The mental status examination aids in the collection of what type of data? a. Covert b. Physical c. Objective d. Subjective
C The mental status exam mostly aids in the collection of objective data.
Your patient, Emma, is crying in your one-to-one session while telling you of her father's recent death from a car accident. Which of the following responses illustrates empathy? a. "Emma, I'm so sorry. My father died two years ago, so I know how you are feeling." b. "Emma, you need to focus on yourself right now. You deserve to take time just for you." c. "Emma, that must have been such a hard situation to deal with." d. "Emma, 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.
The nurse best ensures appropriate client care when choosing an intervention from a Nursing Interventions Classification that matches both a. the condition's etiology and the client's symptomatology. b. the nursing diagnosis and the condition's etiology. c. the defining data and the nursing diagnosis. d. the medical diagnosis and the nursing diagnosis.
C When choosing nursing interventions from the Nursing Interventions Classification or some other source, the nurse selects interventions that fit the nursing diagnosis (e.g., risk for suicide) and that match the defining data.
When a nurse is biased against a client, those feelings will likely make it difficult to a. assess the client's symptoms. b. assess boundary issues with the client. c. view the client with positive regard. d. engage in values clarification with the client.
C Whenever a nurse harbors negative feelings about a client, these feelings stand in the way of objectivity and reduce his or her ability to give the client positive regard.
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
A patient states he has "given up on life." His wife left him, he was fired from his job, and he is four payments behind on his mortgage, meaning he will soon lose his house. Which nursing diagnosis is appropriate? a. Anxiety related to multiple losses b. Defensive coping related to multiple losses c. Ineffective denial related to multiple losses d. Hopelessness related to multiple losses
D
A nurse is interviewing a new client who is angry and highly suspicious. When asked about sexual orientation, the client becomes highly distressed and threatens to walk out of the interview. The nurse responds a. "I would like you to stay and answer the question." b. "Don't be concerned. I accept homosexuals as well as heterosexuals." c. "Your distress leads me to believe you may have something you don't want to discuss." d. "I can see that this topic makes you uncomfortable. We can defer discussion of it today."
D A cardinal rule of interviewing is "Don't probe sensitive areas." Clients are allowed to take the lead.
Which criterion is NOT essential when the nurse plans nursing interventions designed to meet a specific goal? a. Safe b. Evidence based c. Individualized d. Economical
D Although expense should be considered, interventions are chosen based on the other options and not on their economic value.
The nurse best assesses the client's spiritual life by asking, 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 Asking the client to define the role of religion in their life allows for discussion related to the other topics.
Which activity is NOT considered a purpose of the initial psychiatric assessment? a. Obtaining understanding of the current problem b. Identifying treatment goals c. Formulating a plan of care d. Evaluating the results of intervention
D At an initial assessment, no interventions would have taken place; hence evaluation is not a purpose of the initial contact.
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 that he is a. demonstrating symptoms of bipolar disorder. b. socially deviant. c. egocentric. d. not demonstrating any definitive signs of mental illness.
D One myth about mental illness is that to be mentally ill is to be different and odd. Another misconception is that to be healthy, a person must be logical and rational. Everyone dreams "irrational" dreams at night, and "irrational" emotions are universal human experiences and are essential to a fulfilling life. Some people who show extremely abnormal behavior and are characterized as mentally ill are far more like the rest of us than different from us. No obvious and consistent line between mental illness and mental health exists.
Which response to a patient's question of why you need to conduct an assessment interview best explains its purpose? 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 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.
The prevalence rate over a 12-month period for major depressive disorder is a. lower than the prevalence rate for panic disorders. b. greater than the prevalence rate for psychotic disorders. c. equal to the prevalence rate for psychotic disorders. d. greater than the prevalence rate for generalized anxiety.
D Statistics show that the prevalence rate over a 12-month period for major depressive disorder is 6.7%, and the lifetime prevalence rate for generalized anxiety is 3.1%.
The outcome of the nurse's expressions of sympathy instead of empathy toward the client often leads to a. enhanced client coping. b. lessening of client emotional pain. c. increased hope for client improvement. d. decreased client communication.
D Sympathy and the resulting projection of the nurse's feelings limits the client's opportunity to further discuss the problem.
The phase of the nurse-client relationship that may cause anxieties to reappear and past losses to be reviewed is the 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.
A tool the novice nurse might refer to when writing treatment results criteria is the a. North American Nursing Diagnosis Association (NANDA). b. Joint Commission (formally JCAHO). c. Nursing Interventions Classification (NIC). d. Nursing Outcomes Classification (NOC).
D The Nursing Outcomes Classification is a publication used as a resource across the United States.
You are working with Allison on the inpatient psychiatric unit. Which of the following statements reflect an accurate understanding during which phase of the nurse-patient relationship the issue of termination should first be discussed? a. "Allison, 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. (to fellow nurse): "I haven't met my new patient Allison yet, but I am working through my feelings of anxiety in dealing with a patient who wanted to kill herself." c. "Allison, 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. "Allison, 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.
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 This diagnosis contains all the required components: problem statement, the etiology, and supporting data.
Willis has been admitted to your inpatient psychiatric unit with suicidal ideation. He resides in a halfway house after being released from prison, where he was sent for sexually abusing his teenage stepdaughter. In your one-to-one session he tells you of his terrible guilt over the situation 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 be out of prison." c. "The biggest question is, will you do it again? You will end up right back in prison, and have 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 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 a. congruence. b. empathetic feelings. c. countertransference. d. positive transference.
D Transference involves the client experiencing feelings toward a nurse that belong to a significant person in the client's past.
In the process of trying new values, which step shows the highest commitment to the value? a. Cherishing the value b. Publicly stating affirmation of the value c. Choosing a stand consistent with the value from among several alternatives d. Consistently acting in ways that repeatedly affirm the value
D Values clarification theory puts acting consistently on one's belief as the highest level of the process, following prizing and choosing.
You are assessing a 6-year-old patient. When assessing a child's perception of a difficult issue, which methods of assessment are appropriate? Select all that apply. a. Engage the child in a specific therapeutic game. b. Ask the child to draw a picture. c. Provide the child with an anatomically correct doll to act out a story. d. Allow the child to tell a story.
a, b, c, d
