NU473 Week 1: Evolve Elsevier EAQ Mental Health Foundations and Modes of Care
Which statement by the nurse reflects understanding of therapeutic communication with a client experiencing domestic violence? Select all that apply. o "Tell me about your struggles." o "Everything is going to be okay." o "Get out of the house right away." o "You'll feel better after you leave." o "Why do you stay when he hits you?" o "Why did you return to him after the abuse?"
o "Tell me about your struggles." · "Tell me about your struggles," is therapeutic communication, as it encourages a client to describe their perception. Talking about feelings can help clients clarify their thoughts. "Everything is going to be okay" is falsely reassuring and underrates the client's feelings; it would be better to clarify the client's message. "Get out of the house right away" gives premature advice and assumes that the nurse knows best; it would be better to encourage the client to problem-solve. "You'll feel better after you leave" minimizes the client's feelings and indicates that the nurse is unable to empathize; the nurse would attempt to empathize and explore. "Why do you stay when he hits you?" is a value judgment that prevents problem-solving. The nurse would instead make observations. "Why did you return to him after the abuse?" implies criticism and may make the client defensive. The nurse would ask open-ended questions to avoid this.
Place these client statements in the order that reflects the stages in Kübler-Ross' theory of death and dying. o "I've said all my goodbyes, and now I am so tired." o "That lab is always messing up results and making mistakes." o "It's heartbreaking that I'll never get to know my grandchildren." o "This isn't fair—I played by the rules and now I'm the one who's dying." o "All I really want is to live long enough to see my son graduate from college."
o "That lab is always messing up results and making mistakes." o "This isn't fair—I played by the rules and now I'm the one who's dying." o "All I really want is to live long enough to see my son graduate from college." o "It's heartbreaking that I'll never get to know my grandchildren." o "I've said all my goodbyes, and now I am so tired." · The first phase is denial. The statement blaming the lab ("why me?") reflects denial because the client is assuming that there has been an error in diagnosis. The second phase is anger; the assertion that the situation is not fair ("why me?") reflects anger because the client is upset about the terminal illness when the client engaged in wellness behaviors throughout life. The third phase is bargaining. Expressing a wish to see a son graduate ("yes, me, but") reflects bargaining because the client is expressing a desire for more time to live. The fourth phase is depression. This statement ("yes, me") reflects depression because the client is sad about what will never be. The fifth phase is acceptance. The client's announcement of goodbyes reflects preparation for death.
When educating staff about integrating The Joint Commission's National Patient Safety Goals (NPSG) into the behavioral health unit, which statement made by the nurse indicates a need for further teaching? o "We should screen all clients for the risk of suicidal ideations." o "It is important to perform hand hygiene for at least 15 seconds." o "It is required to obtain a current medication list upon admission." o "We should use one client identifier before giving medications."
o "We should use one client identifier before giving medications." · The Joint Commission's NPSG for safety goals include using at least two client identifiers, not one, when providing care, treatment, or services. Therefore the nurse's statement to use only one client identifier indicates a need for further education. All clients should be screened for suicide risk, hand hygiene should be performed for at least 15 seconds, and a current medication list should be obtained upon admission.
A newly graduated nurse is staying after the end of every shift, but duties are usually unfinished. Coming from the nurse coworker, which response is best? o "Don't you think you're trying to do too much?" o "What can I do to help you organize your work?" o "I've noticed that you're staying late every night." o "I'll pass the medications and you finish your work."
o "What can I do to help you organize your work?" · Being understanding and supportive is the best approach for new nurses, and tips for organization are useful. Rhetorical questions (aren't you trying to do too much?) can trigger defensiveness. Observations (I've noticed) present an indirect invitation for the nurse to talk about her situation, but there are better ways to encourage expression of feelings and problem-solving. Volunteering to take some of the work solves the immediate problem, but the nurse still needs the opportunity to share feelings and develop long-term solutions.
Which response is best to give to a client who states, "The voices are saying I killed my husband"? o "You're having very frightening thoughts right now." o "We'll put you in a private room where you'll be safe." o "Tell me more about these worries about your husband." o "I just saw your husband, and he seems to be doing fine."
o "You're having very frightening thoughts right now." · The nurse demonstrates awareness of the client's feelings (frightening thoughts); this opens the channel of communication. A private room is isolating, and this will worsen the hallucinations. Focusing on delusional content (tell me about) reinforces false beliefs. The nurse cannot talk the client out of these delusions by pointing out reality (he's doing fine).
An older client says, "When I was growing up, I was taught to accept my lot in life. I'm proud that I can still function independently, and I don't want to be just put away." Which factors are demonstrated by the client's comment? o Age and gender o Anxiety and depression o Attitudes and beliefs o Cultural and ethnic disparities
o Attitudes and beliefs · Some older people have attitudes and beliefs that include reluctance to seek help because of pride in their independence, stoic acceptance of difficulty, unawareness of resources, and fear of being "put away." The client's comments reflect the passage of time, but gender influence is not evident. The client is expressing some feelings of apprehension over possible loss of independence, but anxiety and depression are not apparent. The client does not mention any ethnic issues, but the comments could reflect the social culture of his youth.
The client phones the mental health clinic and says, "Don't try to help me anymore. I've had enough, and I have a gun in front of me now." Suddenly the call is disconnected. Which action would the nurse take? o Call the local clergy and request an immediate visit. o Call the client back and try to change his mind. o Call 911 and inform the dispatcher of the situation. o Call the family and tell them to go to the house.
o Call 911 and inform the dispatcher of the situation. · This is a serious situation that requires immediate intervention; police and emergency medical services need to go the scene. Calling the client back may be an option, but the 911 dispatcher may request that the line be left open for outgoing calls, or the dispatcher may call the client to further assess the level of danger to self and others. Asking clergy or family to go to the house is unsafe because the client may be dangerous to self and others.
The parents of a toddler who was recently diagnosed with a moderate cognitive impairment state, "Our child should be able to attend college with help and medication." Which conclusion would the nurse make? o They accept the child's diagnosis. o Denial is being used as a defense mechanism. o They want to explore their child's limitations. o Intellectualization helps them gain perspective.
o Denial is being used as a defense mechanism. · The parents are failing to acknowledge reality, and they are in denial. In this situation, the reality is that children with moderate cognitive impairment are unable to succeed at higher education. Medication may help symptoms but will not change the outcome of the disorder. The parents show acceptance when they ask about achievable activities and how to help the child succeed. Parents' statement suggests that they are not ready to explore the child's limitations. Intellectualization would involve discussing the child's problem in a technical manner.
Which behavior indicates that an older widowed client has successfully completed the grieving process? o Formulates a plan to start new relationships o Talks about the deceased spouse at great length o Ignores the deceased's less-than-perfect qualities o Leaves the deceased's study as it was before death
o Formulates a plan to start new relationships · A healthy resolution helps the person move away from the old, safe, familiar relationship to establish new ones. Talking about the deceased spouse at great length is a rumination that suggests the client has not moved on. With a positive outcome to the grieving process, the mourner can acknowledge and accept the dead person's negative and positive qualities. Leaving the deceased spouse's study as it was before the death is an example of mummification, a pathological outcome to the grieving process.
Which behavior would the nurse expect the client to display at the termination of their consistent one-to-one relationship? o Grief o Testing o Splitting o Manipulation
o Grief · Grief reactions to the impending loss and security provided by the one-to-one relationship should be anticipated. Testing behaviors occur early in the one-to-one relationship, not at termination. There should not be a disintegration of the personality (splitting). Manipulative behavior may occur in the early phase of a working relationship.
Which outcome is a mother most likely to experience if she perceives that her child's accidental death was preventable? o Grief grows in intensity and duration o Feelings of loss progress to mental illness o Event is easier to understand and to accept o Mourner experiences a pathological grief reaction
o Grief grows in intensity and duration · Deaths that are perceived as preventable cause more guilt for the mourners and increase the intensity and duration of the grieving process. Perceiving a death as preventable will not necessarily result in a pathological reaction or lead to mental illness, but it will usually make it harder to understand and accept the death.
Which theory is the nurse using in considering relationships and resulting behaviors as the central factors that influence development? o Cognitive theory o Psychosocial theory o Interpersonal theory o Psychosexual theory
o Interpersonal theory · The interpersonal theory of human development by Harry Stack Sullivan highlights interpersonal behaviors and relationships as the central factors influencing child and adolescent development across six "eras"; the need to satisfy social attachments and a longing to meet biological and psychological needs are two dimensions associated with this theory. Cognitive theory is associated with Jean Piaget; cognitive theory explains how thought processes develop, are structured, and influence behavior. Psychosocial theory is associated with Erik Erikson; psychosocial theory identifies social interaction as the source that influences human development. Erikson identified eight stages of human life, with each stage built on the previous stages and influenced by past experiences. Psychosexual theory is associated with Sigmund Freud; psychosexual theory views child development as a biologically driven series of conflicts and gratifying internal needs.
Which intervention would the nurse use for a bedridden client with multiple chronic illnesses, who is usually continent but has started to express anger through urinary incontinence? o Offer the client a bedpan every 2 hours. o Encourage the client to watch more television. o Decrease the client's fluid intake in the evening. o Involve the client in setting realistic short-term goals.
o Involve the client in setting realistic short-term goals. · People with chronic illnesses often feel helpless and powerless. This can turn into anger and acting-out behaviors against those providing care. Involving the client to set and achieve realistic short-term goals fosters client independence and hope. The client can control elimination, so frequent toileting does not address the underlying emotional component. Television does not promote interaction. Fluid intake should be encouraged to preventing urinary stasis and dehydration. Also, restricting fluid intake will not prevent intentional incontinence.
When a client is a member of a different ethnic community, which action would the nurse take? o Ensure that the nurse's biases are understood by the family. o Make plans to counteract the client's misconceptions about therapies. o Offer a therapeutic regimen compatible with the lifestyle of the family. o Recognize that generally all clients just want good nursing care.
o Offer a therapeutic regimen compatible with the lifestyle of the family. · The client cannot be expected to accept or even respond to a plan that is incompatible with the family's lifestyle. The family should not have to adjust to the nurse's biases; the nurse must self-identify biases and ensure that they do not interfere with nursing care. There is no evidence that misconceptions will occur. All individuals want good nursing care, but the perception and ideas of what constitutes good care may be different.
Which intervention would the nurse use to develop a trusting relationship with a disturbed child who acts out? o Ask the child to talk about feelings related to the parents. o Implement one-on-one interactions every half hour. o Offer support and encourage safety during play activities. o Begin setting limits and explain the rules that must be followed.
o Offer support and encourage safety during play activities. · Offering support and encouraging safety during play activities sets a foundation for trust because it allows the child to see that the nurse cares. Inquiring about the child's feelings about the parents is too threatening at this stage of the relationship. Thirty minutes may be too long between interactions; shorter, more frequent contact is better for establishing trust. Setting limits and explaining the rules is necessary, but trust should be developed first.
A client is to be discharged after several months of therapy and anxiously says to the nurse, "I don't know what I'll do when I can't see you anymore." Which behavior is the client manifesting? o Expressing thanks to the nurse o Reacting to the planned discharge o Attempting to manipulate the nurse o Indicating a need for further treatment
o Reacting to the planned discharge · The stress of being discharged and the termination of the nurse-client relationship may precipitate fears and anxiety. The client is expressing fear, not thanks. The client's expression of apprehension is typical in this situation. If the nurse feels manipulated, he or she would self-evaluate for possible countertransference. "I don't know what I'll do" would signal a need for intervention during a crisis, but in light of the impending discharge, the client's statement indicates anxiety over termination.
A newly admitted shy, withdrawn adolescent boy asks an experienced female psychiatric nurse for a date. Which initial response will the nurse use? o Question the client about his sexual identity. o Restate the purpose of the nurse-client relationship. o Suggest that other staff members care for this client. o Review interactions with the client for flirtatiousness.
o Restate the purpose of the nurse-client relationship. · Clients who are inexperienced in psychiatric care may experience confusion about the nurse-client relationship. The nurse would differentiate this professional relationship from a social relationship. This behavior may be a sign of a sexual identity problem, but the nurse would conduct additional assessment before coming to this conclusion. Having other staff members care for the client may be interpreted by the client as rejection. Although nurses would always examine their relationships with their clients, it is unlikely that an experienced nurse would flirt. This is more likely a problem of the client's misinterpretation of his interactions with the nurse.
Which type of therapy is suitable for a client who has unresolved residual feelings after being seen and treated for a physical attack by an unknown assailant? o Psychotherapy that emphasizes desensitization o Short-term therapy emphasizing crisis intervention o Long-term therapy with a psychoanalytical emphasis o Group therapy with a behavior modification component
o Short-term therapy emphasizing crisis intervention · Crisis intervention helps the client put the event in perspective and resolve feelings so the individual can resume life within a short time. Desensitization is effective if the victim develops phobias as a result of the physical attack. Unless there are complicating factors, long-term therapy is not indicated. Behavior modification could be used if the client has provocative or aggressive behaviors that precipitated the attack.
Which intervention will the nurse use for parents who report that their 2-year-old daughter soils herself because she is lazy so they plan to make her wear the soiled clothing to teach her a lesson? o Have child protective services remove the daughter from the home. o Provide a toileting schedule and information regarding effective hygiene. o Refer the parents to classes on anger management and communication skills. o Teach the parents the relationship of developmental milestones to discipline.
o Teach the parents the relationship of developmental milestones to discipline. · The parents' expectation of accident-free toilet training by age 2 years is developmentally unrealistic, and their methods of discipline may cause harm. The nurse would teach what to expect of their child and how to respond. Removing the daughter from the home is an unnecessary intervention unless the situation escalates to serious child endangerment. Instruction in hygiene is helpful, but the underlying issue is the parents' choice of inappropriate discipline for a 2-year-old child. Anger management and communication skills are not the problems.
Which response would the nurse use when a parent of a 13-year-old adolescent with recently diagnosed Hodgkin disease says, "I don't want my child to know about the diagnosis"? o "It's best for your child to know the diagnosis." o "Did you know that the cure rate for Hodgkin disease is high?" o "Would you like someone with Hodgkin disease to talk with you?" o "Let's talk about how you're feeling about your child's diagnosis."
o "Let's talk about how you're feeling about your child's diagnosis." · Initiating a conversation about the client's feelings does not prejudge the parent; it encourages communication. Stating that it is best for the child to know the diagnosis disregards the parent's feelings and cuts off further communication. Asking the client about the cure rate may stop communication and does not recognize the parent's concerns. Offering to have someone with Hodgkin disease speak to the client is premature.
The nurse manager notices that a previously effective nurse appears to be distracted, forgets to document, and rarely completes the workload. Which response would the nurse manager use? o "Your workflow is usually great, but now you seem distracted. What's going on?" o "Why are you are so distracted and forgetful? I need to know what's going on." o "Go ahead and take a break and then come to my office so that we can talk." o "I've noticed that your performance has slipped. Are you using drugs or alcohol?"
o "Your workflow is usually great, but now you seem distracted. What's going on?" · The nurse manager starts with an understanding and supportive approach to help the individual self-identify ("What's going on?") and address the problem. "Why" questions are usually avoided, and this particular why question sounds accusatory. Taking a break after the discussion would be more helpful to the nurse if intense emotional content is disclosed. Changes in performance can be associated with substance abuse, but at this point there is insufficient evidence.
When a client complains about the nursing care, the nurse replies, "We're doing the best we can; others need attention too." Which type of behavior is the nurse displaying? o Impulse control o Defensive behavior o Reality reinforcement o Limit-setting behavior
o Defensive behavior · The nurse's response is not therapeutic because it does not recognize the client's needs but instead tries to make the client feel guilty for being demanding. Impulse control refers to a sudden driving force being constrained or held back. The nurse is not using reality reinforcement or setting limits.
According to psychoanalytical theory, which aspect of personality is underdeveloped in a young woman who has a history of truancy, prostitution, and robbery but has no concern for the emotional distress she has caused to others? o Id o Ego o Superego o Limbic system
o Superego · Lack of remorse indicates a weak superego, the aspect of personality concerned with prohibitions. The id is not underdeveloped in this person; the id acts to achieve self-gratification. The ego is not related to acting-out behavior. The limbic system is not underdeveloped; it is related to the achievement of pleasure.
Which response would the nurse initially use when a 15-year-old client tearfully states that her father has been sexually abusing her for the past 8 years? o "Which type of incidents preceded the abuse?" o "Sharing this information is a positive step in getting help." o "I have to report this to child protective services right now." o "What kinds of things does he do to you when he abuses you?"
o "Sharing this information is a positive step in getting help." · The nurse starts by giving emotional support and indicates that sharing this information is acceptable and provides hope that the client will get help. Asking about incidents that preceded the abuse may precipitate or increase feelings of guilt. Child protective services needs to be contacted and the details of the abuse will eventually need to be documented, but the client needs immediate emotional support.