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Psych Exam 1

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1 (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.)

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 1. is displaying deviant behavior. 2. cannot accurately appraise reality. 3. is seriously and persistently mentally ill. 4. should be considered for group home placement.

A 43-year-old female patient is brought to the emergency department with complaint 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: 1. to avoid a lawsuit. 2. medical conditions and physical illnesses may mimic psychiatric illnesses; therefore, physical causes of symptoms must be ruled out. 3. emergency room physicians are required to order a certain number of tests for the emergency department to be reimbursed. 4. to comply with hospital standards of care.

3 (To prepare clients for discharge, nurses should focus on precipitants of the crisis that led to hospital admission.)

A chronically ill client was readmitted when symptoms of the illness exacerbated. The client lives alone and has few outside activities. To best prepare the client for discharge, the nurse will focus on 1. improving client-family relationships. 2. placing the client in a sheltered workshop. 3. psychoeducation to promote medication compliance. 4. involving the client in daily visits to a psychosocial club.

A client admitted to the behavioral health unit with a diagnosis of schizophrenia tells the nurse that she does not wish to see her husband if he visits. The nurse tells the client's husband that 1. his wife has the right to refuse visitors if she wishes. 2. he is welcome to visit but may receive a cool reception. 3. the client's plan of care calls for limiting visitors for 2 days. 4. the client is acutely psychotic and not responsible for her present behavior.

1 (An unconditional discharge gives the client complete freedom to choose or reject follow-up care. A conditional discharge imposes a legal requirement for the client to submit to follow-up supervision.)

A client is released from involuntary commitment by the judge, who orders that a caseworker supervise him for the next 6 months. This is an example of 1. conditional discharge. 2. outpatient commitment. 3. voluntary follow-up. 4. discretionary treatment.

2 (Many culture-bound illnesses, such as ghost illness, or hwa byung, seem exotic or irrational to American nurses. Many of these illnesses cannot be understood within a Western medicine framework. Their causes, manifestations, and treatments do not make sense to nurses whose understanding is limited to a Western perspective on disease and illness.)

A client reporting gastric pain, tells the nurse, "I think my symptoms started when a neighbor cast a spell on me." The assessment the nurse can make is that the client 1. has a major mental illness. 2. is expressing a culture-bound illness. 3. requires hospitalization to protect the neighbor. 4. will probably not respond to Western medical treatment.

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 1. self-disclosure in an appropriate way. 2. to the client permission to continue. 3. countertransference. 4. empathy to establish trust.

4 (The Tarasoff ruling makes it necessary for nurses to report client statements that imply the client may harm another person or persons. The nurse reports to the treatment team, and the mandated reporter -usually the professional leader of the team- is responsible for notifying the person against whom the threat was made.)

A client reports to the nurse that once he's released he will make sure his wife will never again be able to have him committed to a psychiatric hospital. What action should the nurse take? 1. None, because no explicit threat has been made. 2. Ask the client if he is threathening his wife. 3. Call the client's wife and report the threat. 4. Report the incident to the client's therapist and document.

A client states "That nurse nevers seems comfortable being with me." The nurse can be described as 1. not seeming genuine to the client. 2. transmitting fear of clients. 3. unfriendly and aloof. 4. controlling.

2 (The appraisal of reality is lacking for this client. The client does not have a picture of what is happening around himself or herself.)

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? 1. Control over behavior 2. Appraisal of reality 3. Effectiveness in work 4. Healthy self-concept

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 1. congruence. 2. empathetic feelings. 3. countertransference. 4. positive transference.

2 (Every client has the right to be treated with dignity. This statement is demeaning.)

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 states: 1. "We will help you make decisions that will keep you safe." Incorrect 2. "I am going to help you shower, so you will not smell so bad." 3. "Your pocket knife and nail clippers will be kept in the nurses' station." 4. "You will be having a number of tests to help us learn about your condition."

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

A client who presents no danger to himself or to others is forced to take medication against his will. This situation represents 1. assault. 2. battery. 3. defamation. 4. invasion of privacy.

4 (Interpersonal psychotherapy is considered to be effective in resolving problems of grief, role disputes, role transition, and interpersonal deficit.)

A client with a history of three failed engagements is concerned about being "too possessive." This concern supports a need for which type of therapy? 1. Psychodynamic. 2. Cognitive. 3. Behavioral. 4. Interpersonal.

1 (Cognitive therapists help clients identify, reality test, and correct distorted conceptualizations and dysfunctional beliefs, such as realizing that doing a stupid thing does not mean the person is stupid.)

A cognitive therapist would help a client restructure the thought "I am stupid!" to 1. "What I did was stupid." Correct 2. "I am not as smart as others." 3. "Things usually go wrong for me." 4. "Things like this should not happen to anyone."

1 (Use of a translator is helpful with language and with gaining explanations of culture as it might affect health care.)

A community mental health nurse is assigned to a mobile mental health care unit in a locale where the majority of the population are newly immigrated Vietnamese. The measure that will best help the nurse initially plan and implement culturally sensitive care for clients is 1. arranging for the services of an interpreter and cultural consultant. 2. reading about the predominant health beliefs held by members of Asian cultures. 3. attempting to place self in the position of being an unassimilated member of a culture. 4. treating clients in the same manner that clients of any culture would find satisfying.

1 (Empowerment implies supporting the client to act on his or her own behalf. A client who is empowered takes responsibility for aspects of his or her own care, such as medication compliance. Having the client function at the highest level at which he or she is capable is always a goal of care; the more autonomous the client can be, the better.)

A community mental health nurse is responsible for medication management for clients. Which general approach can be anticipated to yield the best results? 1. Empowering clients to be responsible for medication compliance 2. Providing frequent oversight by nurse of daily medication ingestion 3. Establishing a system in which client support figures oversee medications 4. Scheduling monthly blood tests to determine serum levels of prescribed medications

positive

A consequence can be a _____ reinforcement, such as receiving a reward (getting a 3.8 GPA after studying hard all semester), or a ______ reinforcement such as the removal of an objectionable or adverse stimulus (walking freely through a park once the vicious dog is picked up by the dog catcher).

A family who is worried that an adult female might hurt herself asks for her to be admitted to the hospital. An assessment indicates moderate depression with no risk factors for suicide other than a depressed mood. The patient denies any intent or thoughts about self-harm. The family agrees she has not done or said anything to suggest she might be a danger to herself. Which of the following responses is consistent with the concept of "least restrictive" alternative doctrine? 1. admit the patient as a temporary inpatient admission. 2. persuade the patient to agree to a voluntary inpatient admission. 3. admit the patient involuntarily to an inpatient mental health treatment unit. 4. arrange for an outpatient counseling appointment the next day.

A friend recognizes that his depression has returned and tells you he is suicidal and afraid he will harm himself. He wishes to be hospitalized but does not have health insurance. Which of the following responses best meets his immediate care needs and reflects the options for care a person in his position typically has? 1.provide emotional support and encourage him to contact his family to see if they can help him arrange and pay for inpatient care. 2. advise him that hospitals serve all persons regardless of their ability to pay and immediately contact a Mobile Crisis team or accompany him to the nearest hospital emergency department. 3. help him apply for Medicaid coverage, arrange for him to be monitored by family and friends, and once Medicaid coverage is in place, take him to an emergency room for evaluation. 4. assist him in obtaining an outpatient counseling appointment at an area community mental health center, and call him frequently to assure he is safe until his appointment occurs.

4 (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.)

A function shared by advanced practice and general practice psychiatric nurses is 1. prescriptive authority. 2. hospital privileges. 3. provision of consultation services. 4. collaboration with a multidisciplinary team.

A male patient frequently inquires about the female student nurse's boyfriend, social activity, and school experiences. Which of the following initial responses by the student best addresses the issue raised by this behavior? 1. the student requests assignment to a patient of the same gender as the student. 2. she limits sharing personal information and stresses the patient centered focus of the conversation. 3. she tells him that she will not talk about her personal life. 4. she explains that if he persists in focusing on her, she cannot work with him.

1 (Other clients are usually taken to a safe area away from the scene of the crisis. The nurse should allow clients to express their fears, which often include fear of bodily harm from the acting-out client, fear that they, too, could lose control, and fear for the other client's safety. The nurse should provide realistic reassurance for expressed concerns.)

A novice nurse is assigned to manage the milieu when there is a behavioral crisis with a client in the dining room. The nurse shows a lack of understanding of crisis management when 1. requiring that all clients go in their rooms. 2. moving clients from the dining room to the day room/solarium. 3. encouraging the clients to express their reactions to the incident. 4. reassuring clients that staff will handle the agitated client.

3 (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 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 1. ask the client if she needs her glasses and hearing aid. 2. give the client her glasses and hearing aid. 3. assist the client in putting on glasses and hearing aid. 4. explain the importance of wearing her hearing aid and glasses.

1 (Autonomy refers to self-determination. Self-determination can be exercised when one makes his or her own decisions without interference from others.)

A nurse is adequately representing the stated bioethical principle when valuing 1. autonomy by respecting a client's right to decide to refuse cancer treatment. 2. justice by staying with a client who is suicidal. 3. fidelity by informing the client about the negative side effects of a proposed treatment. 4. beneficence when advocating for a client's right to enter into a clinical trial for a new medication.

4 (A cardinal rule of interviewing is "Don't probe sensitive areas." Clients are allowed to take the lead.)

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 1. "I would like you to stay and answer the question." 2. "Don't be concerned. I accept homosexuals as well as heterosexuals." 3. "Your distress leads me to believe you may have something you don't want to discuss." 4. "I can see that this topic makes you uncomfortable. We can defer discussion of it today."

A nurse makes a post on social media page about his peer taking care of a patient with a crime-related gunshot wound during his shift in the ED. He does not use the name of the patient. It can be concluded that: 1. the nurse has not violated any confidentiality laws because she did not use the patient's name. 2. the nurse cannot be held liable for violating confidentiality laws because he was not the primary nurse for the patient. 3. the nurse has violated confidentiality laws and can be held liable. 4. the nurse cannot be held liable because postings on a social media site are excluded from confidentiality laws.

2 (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.)

A nurse says, "I work with a mobile mental health unit." The listener can assume that the nurse 1. works with patients who are incarcerated. 2. sees clients in unconventional settings. 3. is a preferred provider for a large HMO. 4. is a clinical specialist with the visiting nurse service.

2 (Highly emotional verbal communication accompanied by dramatic body language when describing emotional problems is a style associated with persons of Hispanic culture. French and Italian Americans also demonstrate animated facial expressions and expressive hand gestures during communication.)

A nurse should perceive an intense, highly emotional communication style as culturally appropriate for a client who is 1. African American. 2. Hispanic American. 3. Asian American. 4. British American.

2 (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.)

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: 1. becoming active in politics leading to a potential political career. 2. reducing the stigma of mental illness and advocating for equality in treatment. 3. encouraging laws that would make the involuntary long-term commitment process easier and faster for caregivers of mentally ill persons. 4. advocating for reduced mental health insurance benefits to discourage abuse of the system by inappropriate psychiatric admissions.

3 (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.)

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: 1. "Don't be afraid; it means I'm here to help, not hurt, you." 2. "Psychiatric mental health nurses care for people with mental illnesses." 3. "We have the specialized skills needed to care for those with mental illnesses." 4. "The nurses who work in mental health facilities have that title."

3 (Nursing diagnoses provide the framework for identifying appropriate nursing interventions for dealing with the phenomena a client with a mental health disorder is experiencing.)

A nursing diagnosis for a client with a psychiatric disorder serves the purpose of 1. justifying the use of certain psychotropic medication. 2. providing data essential for insurance reimbursement. 3. providing a framework for selecting appropriate interventions. 4. completing the medical diagnostic statement.

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 specific psychiatric disorders. The best answer would be: 1. NIC 2. NOC 3. NANDA-I 4. DSM-5

A patient states that 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? 1. anxiety related to multiple losses. 2. defensive coping related to multiple losses. 3. ineffective denial related to multiple losses. 4. hopelessness related to multiple losses.

3 (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 ethnicity and culture.)

A peer asks you to help him differentiate between culture and ethnicity for clarification. Which statement by the peer would acknowledge that you had appropriately helped him clarify the difference between the two terms? 1. "So, ethnicity refers to having the same life goals whereas culture refers to race." 2. "So, ethnicity refers to norms within a culture, and culture refers to shared likes and dislikes." 3. "So, ethnicity refers to shared history and heritage, whereas culture refers to sharing the same beliefs and values." 4. "So, ethnicity refers to race, and culture refers to having the same worldview."

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? 1. sitting attentively in silence with a withdrawn patient until he chooses to speak. 2. offering the patient advice on how he could cope more effectively with stress. 3. controlling the pace of the relationship by selecting topics for each interaction. 4. limiting the discussion of termination issues so as not to sadden the patient unduly.

3 (According to Freud's psychosexual stages of development, this client is exhibiting the oral -0-1 year- personality traits: fixation at the oral stage is associated with passivity, gullibility, and dependence; the use of sarcasm; and the development of orally focused habits e.g., smoking, nail biting.)

A suspicious client who smokes several packs of cigarettes daily and drinks large quantities of coffee and soda as he is able to afford reacts to every nursing intervention with sarcasm. When asking for advice, the nurse manager's most helpful response is 1. "You are dealing with a very difficult and resistant client; just keep with your plan." 2. "If you haven't been able to establish client trust by now, ask for a change of assignment." 3. "Remember that sarcasm represents the oral-stage fixation of development." 4. "You are attempting to work with a client who likes to keep others off-balance."

A tool the novice nurse might refer to when writing treatment results criteria is the 1. North American Nursing Diagnosis Association (NANDA). 2. Joint Commission (formally JCAHO). 3. Nursing Interventions Classification (NIC). 4. Nursing Outcomes Classification (NOC).

tort

A(n) ____ is a civil wrong for which money damages may be collected by the injured party (plaintiff) from the responsible party (defendant). Intentional: willful or intentional acts that violate another person's rights or property. Ex: assault (verbal or physical), battery (touching), false imprisonment, invasion of privacy (damage to self esteem), defamation of character (slander [oral] or libel [written]). Unintentional: unintended acts against another that produces harm or injury. Ex: negligence (failing to do what a reasonable and prudent nurse would do in similar circumstances resulting in injury) and malpractice.

ethical dilemma

A(n) _____ _____ results when there is a conflict between two or more courses of action, each carrying favorable and unfavorable consequences. The responses to this is partly based on morals and values.

mental illness

A(n) ______ ______ is defined as disorders with a definable diagnosis. Odd behavior does not necessarily negate a diagnosis. Look to see if their is significant dysfunction related to developmental, biological (genetic loading factor such as schizo or bipolar disorder), or physiologic (medication side effects) disturbances.

comorbid

A(n) ______ condition refers to an individual that has more than one mental disorder at a time.

3 (Freud described the conscious part of the mind as the tip of the iceberg. It contains all of the material that the person is aware of at any one time.)

According to Freud, the nurse recognizes that a client experiencing dysfunction of the conscious as part of the mind will have problems with 1. only recent memory. 2. both recent and long-term memory. 3. all material that the person is aware of at any one time. 4. only material that should be easily retrieved.

3 (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.)

According to Rogers, a synonym for genuineness is 1. respect. 2. empathy. 3. congruence. 4. positive regard.

CBT (cognitive behavior therapy)

Aaron Beck, another adherent of Sigmund Freud's tenets, was originally trained in psychoanalysis but is regarded as a Neo-Freudian. When he attempted to study depression from a psychoanalytical perspective, he became convinced that people with depression generally had stereotypical patterns of negative and self-critical thinking that seemed to distort their ability to think and process information. ______ is based on both cognitive psychology and behavioral theory. It is an active, directive, time-limited structured approach used to treat a variety of psychiatric disorders (depression, anxiety, phobias, and pain problems).

anxiety

According to Sullivan, the purpose of all behavior is to get needs met through interpersonal interactions and to decrease or avoid ______, which is any painful feeling or emotion that arises from social insecurity or prevents biological needs from being satisfied.

1 (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.)

According to the DSM-5, there is evidence that symptoms and causes of mental illness are influenced by: 1. cultural and ethnic factors. 2. occupation and status. 3. birth order. 4. sexual preference.

1 (Disease has a cause e.g., pathogens, toxins that creates the effect; disease can be observed and measured.)

According to the Western scientific view of health, illness is the result of 1. pathogens. 2. energy blockage. 3. spirit invasion. 4. soul loss.

After a client discusses her relationship with her father, the nurse asks, "Tell me if I'm correct that you feel dominated and controlled by him?" The nurse's purpose is to 1. elicit more information. 2. encourage evaluation. 3. verbalize the implied. 4. clarify message.

3 (Confidentiality extends to death and beyond. Nurses should never disclose information after the death of a client that they would have kept confidential while the client was alive.)

After the death of a client, what rule of confidentiality should be followed by nurses who provided care for the individual? 1. Confidentiality is now reserved to the immediate family. 2. Only HIV status continues to be protected and privileged. 3. Nothing may be disclosed that would have been kept confidential before death. 4. The nurse must confer with the next of kin before divulging confidential, sensitive information.

4 (Public discussion of mental illness by famous political, entertainment, and sports figures has proven helpful in minimizing the stigma attached to problems such as depression, anxiety, and eating disorders.)

Although mental illness still carries a stigma, acceptance has improved over the past 40 years, partly due to 1. better control of symptoms through drug therapy. Incorrect 2. public screenings that are well advertised in the community. 3. community psychiatric nursing programs that provide in-home care. 4. acknowledgment of personal mental health issues by well-known people.

Amanda was raised by an abusive and rejecting father and had a difficult childhood. An 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 takes 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. 1. Amanda is experiencing transference; Jane should help Amanda to understand that she is emphasizing in Jane all those characteristics that were missing in her father. 2. Jane is idealizing Amanda, seeing in her strengths and abilities that Amanda does not possess; Jane should temporarily distance herself somewhat from Amanda. 3. Amanda is over-identifying with Jane, seeing similarities that in reality do not exist; Jane should label and explore this phenomenon in her interactions with Amanda. 4. 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.

An action that is acceptable in a social relationship but not in a therapeutic relationship is 1. giving advice. 2. listening actively. 3. clarifying feelings. 4. giving positive regard.

2 (Deinstitutionalization involves interventions that move a hospitalized mental health client into community-based outpatient services.)

An example of deinstitutionalization would include 1. providing a recovering alcoholic with transportation to nightly AA meetings. 2. discharging a stabilized psychotic client to a transitional halfway house. 3. psychiatric in-home visits for a new mother experiencing post-partum depression. 4. conducting regular depression screening at a local homeless shelter.

3 (Erikson placed greater emphasis on the role of the ego. He also stressed that an individual's development is influenced by more than the restricted mother-child-father triangle and that culture and society exert significant influence on personality. Sigmund Freud advanced the first theory of personality development and articulated levels of awareness -unconscious, preconscious, conscious- and demonstrated the influence of our unconscious behavior on everyday life, as evidenced by the use of defense mechanisms. Freud identified three psychological processes of personality -id, ego, superego- and described how they operate and develop and articulated one of the first modern developmental theories of personality, based on five psychosexual stages.)

An important difference between the developmental theories of Freud and Erikson is 1. Freud considers the entire life span from birth to old age. 2. Freud focuses to a greater extent on cognitive development. Incorrect 3. Erikson viewed individual growth in terms of social setting. Correct 4. Erikson focuses on the development of individual moral thinking.

4 (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.)

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 1. demonstrating symptoms of bipolar disorder. 2. socially deviant. 3. egocentric. 4. not demonstrating any definitive signs of mental illness.

2 (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.)

An ongoing, crucial responsibility of nurses working on an inpatient psychiatric unit is 1. fostering research. 2. maintaining a therapeutic milieu. 3. sympathetic listening. 4. providing constructive negative feedback.

Anna, a patient at the community mental health center, tends to stop taking her medications at intervals, usually leading to decompensation. Which of the following interventions would most likely improve her adherence to her medications? 1. help anna to understand her illness and share in decision making about her care. 2. advise anna that if she stops her medications, her doctor will hospitalize her. 3. arrange for anna to receive daily home care so that her use of medication is monitored. 4. discourage anna from focusing on side effects and other excuses for stopping her pills.

4 (Sullivan demonstrated that a psychotherapeutic environment, revolving around an accepting atmosphere that provides numerous opportunities for practicing interpersonal skills and developing relationships, is an invaluable treatment tool. This method is used today in virtually all residential and day hospital settings.)

As a result of Harry Stack Sullivan's work, the mental health nurse is involved in providing clients with 1. security operations. 2. psychoanalysis. 3. analysis of behavior patterns. 4. a psychotherapeutic environment.

Automatic thoughts and cognitive distortions are terms that relate to: 1. behavioral therapy. 2. cognitive-behavioral therapy. 3. operant conditioning theory. 4. biofeedback.

Client reactions of intense hostility or feelings of strong affection toward the nurse are common forms of 1. resistance. 2. transference. 3. countertransference. 4. emotional abreaction.

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? 1. "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." 2. "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!" 3. "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." 4. "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."

fidelity

Bioethics is the study of specific ethical questions that arise in health care. It is divided into 5 basic principles: _____ (nonmaleficence) is maintaining loyalty and commitment to the patient and doing no wrong to the patient. Ex: maintaining expertise in nursing skill through nursing education.

veracity

Bioethics is the study of specific ethical questions that arise in health care. It is divided into 5 basic principles: _____ is one's duty to communicate truthfully. Ex: describing the side effects and purpose of psychotropic medications in a truthful and non misleading way.

autonomy

Bioethics is the study of specific ethical questions that arise in health care. It is divided into 5 basic principles: _____ is respecting the rights of others to make their own decisions. Ex: acknowledging the patient's right to refuse medication.

beneficence

Bioethics is the study of specific ethical questions that arise in health care. It is divided into 5 basic principles: _____ is the duty to act to benefit or promote the good of others. Ex: spending extra time to help calm an extremely anxious patient.

justice

Bioethics is the study of specific ethical questions that arise in health care. It is divided into 5 basic principles: _____ is the duty to distribute resources or care equally, regardless of personal attributes. Ex: an ICU nurse devotes equal attention to some one who has attempted suicide as to someone who suffered a brain aneurysm.

Brian, a patient with schizophrenia, has been ordered an antipsychotic medication. This medication will likely benefit him, but there are side effects; in a small percentage of patients, it may cause a dangerous side effect. After medication teaching, Brian is unable to identify side effects and responds, "I won't have any side effects because I am iron and cannot be killed." Which response would be most appropriate under these circumstances? 1. administer the medication because Brian has made a decision to take the medication and care should be patient-centered. 2. petition the court to appoint a guardian for Brian, as he is unable to comprehend the proposed treatment. 3. administer the medication because Brian's need for treatment is the clear priority. 4. withhold the medication until Brian is able to identify the benefits and risks of both consenting and refusing consent to the medication.

3 (Inaccurate information or insufficient information may be obtained if the interviewer is not culturally sensitive. Only when assessment data are accurate can effective treatment be planned.)

Clients of another culture are at greatest risk for misdiagnosis of a psychiatric problem because of 1. biased assessment tools. Incorrect 2. insensitive practitioners. 3. insensitive interviewing techniques. 4. lack of the availability of cultural translators.

epidemiology

Clinical ______ is a broad field that examines health and illness at the population level. Studies use traditional methods and are conducted in groups usually defined by the illness or symptoms or by the diagnostic procedures or treatments given for the illness or symptoms.

1 (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.)

Current information suggests that the most disabling mental disorders are the result of 1. biological influences. 2. psychological trauma. 3. learned ways of behaving. 4. faulty patterns of early nurturance.

2 (Power and control are often products of culturally determined beliefs about who should hold power. In many cultures the elderly are venerated. In other cultures women are virtually powerless. For some cultures, higher education equates with power.)

Data concerning client age, sex, education, and income should be the focus of an assessment in order to best understand cultural issues related to 1. health practices. 2. power and control. 3. psychological stability. 4. assimilation and conformity.

David has an overnight pass, and plans to spend the night with his sister and her family. As you meet with the patient and his sister just prior to the pass, the sister mentions that she has missed her brother and needs him to babysit. You notice that the patient becomes visibly agitated when she says this. How do you balance safety and the patient's right to confidentiality? 1. cancel the pass without explanation to the sister, and reschedule it for a time when babysitting would not be required of the patient. 2. suggest that the sister make other arrangements for child care, but withhold information the patient shared regarding his concerns about harming children. 3. speak with the patient about the safety risk involved in babysitting, seeking his permission to share this information and advising against the pass is he declines to share the information. 4. meet with the patient's sister, sharing with her the patient's previous disclosure about his anger toward children and the resultant risk that his babysitting would present.

4 (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.")

Deviation from cultural expectations is considered by members of the cultural group as a demonstration of 1. hostility. 2. lack of self-will. 3. variation from tradition. 4. illness.

2 (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.)

During the initial assessment interview with a psychiatric client, the nurse should regard the spiritual assessment as 1. optional. 2. important to complete. 3. less relevant than the cultural assessment. 4. relevant only when the client is oriented.

During what stage of the therapeutic nurse-client relationship is a formal or informal contract between the nurse and client established? 1. Preorientation 2. Orientation 3. Working 4. Termination

Emily is a 28 y/o nurse on the psych unit. She has been working with Jenna, a 27 y/o who was admitted with depression. Emily and Jenna find they have so much in common, including each having a 2 y/o 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: 1. successful termination. 2. promoting interdependence. 3. boundary blurring. 4. a strong therapeutic relationship.

Epidemiological studies contribute to improvements in care for individuals with mental disorders by: 1. providing information about effective nursing techniques. 2. identifying risk factors that contribute to the development of a disorder. 3. identifying who in the general population will develop a specific disorder. 4. identifying which individuals will respond favorably to a specific treatment.

3 (Unless clients have faith in a particular healing modality, the treatment may not be effective. When nurses make assessments on the basis of Western theories, treatments consistent with those assessments follow. Clients of other cultures may find the treatment modalities unacceptable or not useful. Treatments consistent with the client's cultural beliefs as to what will provide a cure are better.)

Exclusive use of Western psychological theories by nurses making client assessments will result in 1. a high level of care for all clients. 2. standardization of nomenclature for psychiatric disorders. 3. inadequate assessment of clients of diverse cultures. 4. greater ease in selecting appropriate treatment interventions.

2 (Newly admitted clients can find the interaction with numerous team members stressful or even threatening.)

For the psychiatric client, the greatest negative aspect of the multidisciplinary treatment team approach to care is that it 1. is an expensive treatment model. 2. can increase anxiety in the newly admitted client. 3. requires the client to answer the same questions repeatedly. 4. puts demands on the client's time and energy.

grief, role disputes, role transition, interpersonal deficit

Four types of problem areas identified in interpersonal psychotherapy include: ______ which is a complicated bereavement following the death or loss of a loved one; ___ ___ which are conflicts with a significant other; ____ _____ which are problematic changes in life status or social or vocational role; _____ _____ which is an inability to initiate or sustain close relationships.

Freud (1960) delineated three major and distinct but interactive systems of the personality. At birth we are all _____, which is the source of all drives, instincts, reflexes, needs, genetic inheritance, and capacity to respond, as well as the wishes that motivate us. It cannot tolerate frustration and seeks to discharge tension and return to a more comfortable level of energy. It lacks the ability to problem solve; it is not logical and operates according to the pleasure principle. The only needs that count are its own. A hungry, screaming infant is the perfect example.

superego

Freud (1960) delineated three major and distinct but interactive systems of the personality. The ______ is the last portion of the personality to develop and represents the moral component of personality. It consists of the conscience (all the should nots internalized from parents) and the ego ideal (all the shoulds internalized from parents). It represents the ideal rather than the real; it seeks perfection, as opposed to seeking pleasure or engaging reason.

ego

Freud (1960) delineated three major and distinct but interactive systems of the personality. Within the first few years of life as the child begins to interact with others, the ______ develops. This is the problem solver and reality tester. It is able to differentiate subjective experiences, memory images, and objective reality and attempts to negotiate with the outside world. It follows the reality principle, which says to the id, "you have to delay gratification for right now," and then sets a course of action. For example, a hungry man feels tension arising from the id that wants to be fed. This allows him not only to think about his hunger but to plan where he can eat and to seek that destination. This process is known as reality testing because the individual is factoring in reality to implement a plan to decrease tension.

2 (The ego develops defenses or defense mechanisms to ward off anxiety by preventing conscious awareness of threatening feelings.)

Freud believed that individuals cope with anxiety by using 1. the superego. 2. defense mechanisms. 3. security operations. 4. suppression.

1 (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. Recovery is usually not a short-term journey but rather a long-term journey. While recovery may be a long-term journey over months or even years, it would not cover an entire life span.)

George W. Bush's New Freedom Commission on Mental Health's report emphasized that mental illness is not a hopeless life sentence but a condition from which people can recover. Recovery, which is still the number 1 goal, could be described as: 1. the ability to work, live, and participate in the community. 2. never having to visit a mental health provider again. 3. a short-term journey that leaves people better able to cope with symptoms. 4. a long-term journey over the individual's life span.

personality

Harry Stack Sullivan defined _____ as behavior that can be observed within interpersonal relationships. This premise led to the development of his interpersonal theory.

1 (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.)

High levels of anxiety and maladaptive behavior are seen 1. in all areas in the health care setting. 2. only in the psychiatric mental health setting. 3. where death is a frequent outcome despite treatment. 4. when the nurse and client have yet to establish a therapeutic relationship.

3 (False imprisonment is the arbitrary holding of a client against his or her will. When seclusion is ordered, it is not invoked arbitrarily, but after other less restrictive measures have failed. If the client is secluded without the medical order, the measure cannot be proven as instituted for medically sound reasons.)

If a client is placed in seclusion and held there for 24 hours without a written order or examination by a physician, the client has experienced 1. battery. 2. defamation of character. 3. false imprisonment. 4. assault.

3 (An incompetent client is unable to make legal decisions that would affect his care, such as consenting to surgery. A court-appointed guardian functions on behalf of the client.)

If a client with psychiatric illness is determined to be incompetent to make decisions affecting his care 1. Staff members are required to use their best judgment when defining care. 2. No treatment other than custodial care can be provided. 3. The court appoints a guardian to make decisions on his behalf. Correct 4. The doctrine of least restrictive alternative is null and void.

3 (Fidelity refers to being "true" or faithful to one's obligations to the client. Client abandonment would be a violation of fidelity.)

If a nurse is charged with leaving a suicidal client unattended, it is being suggested that the nurse's behavior has violated the ethical principle of 1. autonomy. 2. veracity. 3. fidelity. 4. justice.

3 (Community mental health centers were created as a result of the 1963 Community Mental Health Centers Act for the purpose of providing mental health services while maintaining the client in his own community.)

In 1963 the Community Mental Health Centers Act was signed with the primary purpose of 1. having mental health care services funded by the federal government while provided by state government. 2. providing mental health care to the uninsured in an economical reasonable manner. 3. providing mental health care on an outpatient basis in order to maintain the client as a member of an established community. 4. assuring all Americans of the mental health care services they need and/or desire.

(oral, anal, phallic, latency) genital

In Freud's psychoanalytical theory, he lists some psychosexual stages of development. The fifth stage is ______ and occurs from 12 years to beyond. The source of satisfaction are the genitals (sexual intercourse). There are no primary conflicts. The tasks include development of satisfying sexual and emotional relationships, emancipation from parents - planning of life goals, and development of a sense of personal identity. The desired outcomes include the ability to be creative and find pleasure in love and work. Other possible personality traits include the inability to negotiate this stage may derail emotional and financial independence, may impair personal identity and future goals, and disrupt the ability to form satisfying intimate relationships.

oral (anal, phallic, latency, genital)

In Freud's psychoanalytical theory, he lists some psychosexual stages of development. The first is called _____ and occurs from 0-1 year. It includes the mouth as the source of satisfaction (sucking, chewing, biting). Problems in this stage include weaning. The tasks include mastery of gratification of oral needs and beginning of ego development (4-5 months). The desired outcomes include the development of tryst in the environment, with the realization that needs can be met. Other possible personality traits include fixation at the oral stage that can be associated with passivity, gullibility, and dependence; the use of sarcasm; and may develop orally focused habits (smoking, nail biting).

(oral, anal, phallic) latency (genital)

In Freud's psychoanalytical theory, he lists some psychosexual stages of development. The fourth is called _____ and occurs from 6-12 years. There is no source of satisfaction or primary conflicts. The tasks include the growth of the ego functions (social, intellectual, mechanical) and the ability to care about and relate to others outside the home (peers of the same sex). The desired outcomes include the development of skills needed to cope with the environment. Other possible personality traits include fixations that can results in difficulty identifying with others and in developing social skills, leading to a sense of inadequacy and inferiority.

(oral) anal (phalic, latency, genital)

In Freud's psychoanalytical theory, he lists some psychosexual stages of development. The second is called ______ and occurs from 1-3 years. The source of satisfaction comes from the anal region (expulsion and retention of feces). The primary conflict is toilet training. The tasks include the beginning of development of a sense of control over instinctual drives and the ability to delay immediate gratification to gain a future goal. The desired outcomes are control over impulses. Other possible personality traits include fixation at the anal stage associated with anal retentiveness (stinginess, rigid thought patterns, OCD) or anal-expulsive character (messiness, destructiveness, cruelty).

(oral, anal) phallic (latency, genital)

In Freud's psychoanalytical theory, he lists some psychosexual stages of development. The third is called ______ and occurs from 3-6 years. The source of satisfaction are the genitals (masturbation). The primary conflict is oedipus and electra. Tasks include sexual identity with parent of same sex and the beginning of the superego development. Desired outcomes include identification with parent of the same sex. Other possible personality traits include fixation resulting in recklessness, self-assuredness, and narcissism. Lack of resolution may result in inability to love and difficulties with sexual identity.

conscious, preconscious, unconscious

In Freud's talk therapy, he uses the _____ part of the mind as the tip of the iceberg. It contains all the material a person is aware of at any one time, including perceptions, memories, thoughts, fantasies, and feelings. Just below the surface of awareness is the ______, which contains material that can be retrieved rather easily through conscious effort. The ______ includes all repressed memories, passions, and unacceptable urges lying deep below the surface. It is believed that the memories and emotions associated with trauma are often "placed" in the unconscious because the individual finds it too painful to deal with. The individual is usually unable to retrieve this material without the help of a trained therapist.

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

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? 1. Nurses 2. Social workers 3. Clinical psychologists 4. Chemical dependency counselors

3 (One of the most important safety features of a psychiatric unit is the noninstitutional bedroom, which is equipped with many safety-specific features.)

In an attempt to provide both safety and client comfort, psychiatric units generally have 1. a varied client menu served on nonbreakable plastic dinnerware. 2. comfortable seating that is well padded but secured to the floor. 3. bedrooms that resemble hotel rooms but with specific safety features. 4. a dayroom that has audiovisual equipment and is visible from the nurses' station.

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

In order to be most effective, the community mental health nurse involved in assertive community treatment (ACT) needs to possess 1. knowledge of both national and local political activism. 2. the ability to cross service systems. 3. an awareness of own cultural and personal values. 4. creative problem-solving and intervention skills.

2 (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.)

In order to best differentiate whether an Asian client is demonstrating a mental illness when attempting suicide is to 1. ask the client whether he views himself as being depressed. 2. identify his culture's view regarding suicide. explain to him that suicide is often regarded as a desperate act. assess the client for other examples of depressive behaviors.

2 (Standards of practice for psychiatric nursing indicate that the client can be an individual, a family, a group, or a community.)

In psychiatric nursing, assessment of a "client" refers exclusively to 1. an individual with a psychiatric diagnosis. 2. an individual, family, group, or community. 3. any person who seeks the assistance of the psychiatric nurse. 4. the person identified by the system as being in need of treatment.

In the DSM-5, a major change in how culture is viewed within each disorder is that: 1. issues related to culture and mental illness are now integrated into the discussion of each disorder rather than separately discussing culture-bound syndromes. 2. issues related to culture and mental illness are markedly absent in the discussion of each disorder. 3. it is noted that it is impossible for health practitioners to be expected to be culturally aware with the increasing diversity of the U.S. 4. issues related to culture and mental illness are less important than previously thought in the diagnostic criteria.

1 (In the Eastern tradition, disease is believed to be caused by fluctuations in opposing forces, the yin-yang energies.)

In the Eastern tradition, disease is believed to be caused by 1. fluctuations in opposing forces. 2. outside influences. 3. members' disobedience. 4. adoption of Western beliefs.

1 (Legal principles are fundamental to nursing practice. They supersede all other principles, standards, and judgments. All students are encouraged to become familiar with the important provisions of the laws in their own states regarding admissions, discharges, clients' rights, and informed consent.)

In the course of providing best psychiatric care for a client, the nurse must place greatest reliance on 1. legal principles. 2. ethical principles. 3. independent judgment. 4. institutional standards.

In the process of trying new values, which step shows the highest commitment to the value? 1. Cherishing the value 2. Publicly stating affirmation of the value 3. Choosing a stand consistent with the value from among several alternatives 4. Consistently acting in ways that repeatedly affirm the value

ACT (assertive community treatment)

Intense case management for patient's with repeated hospitalizations, severe sx, or inability to participate in traditions tx.

PHP (partial hospital programs)

Intense tx similar to in-patient, but patients go home for the night. Lasts 5-6 hours per day of individual and group tx. LOS is 1-2 weeks. The focus of tx is sx. improvement, safety, education, meds, and coping.

1 (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.)

Interviewer anxiety during an assessment interview is most likely to be a result of 1. the client's perception of the interviewer's ability to help. 2. concern resulting from the need to form a relationship. 3. the nurse's inability to decide on a plan of action. 4. the cultural biases of both the client and the nurse.

4 (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.)

It is not always guaranteed that all clients who are voluntarily admitted to a behavioral health unit will have the right to 1. refuse treatment. 2. send and receive mail. 3. seek legal counsel. 4. access all personal possessions.

James is a 43 y/o patient with schizophrenia. He approaches you as you arrive for day shift and anxiously reports, "Last night demons came to my room and tried to rape me." Which response would be most therapeutic? 1. there is no such thing as demons; what you saw were hallucinations. 2. it is not possible for anyone to enter your room at night; you are safe here. 3. you seem very upset; please tell me more about what you experienced last night. 4. that must have been very frightening, but we'll check on you at night and you'll be safe.

2 (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.)

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? 1. Ineffective coping 2. Spiritual distress 3. Risk for self-harm 4. Hopelessness

1 (Chemical restraints are defined by those medications or doses of medication that are not being used for the patient's condition. Medication time-out is incorrect; false imprisonment and malpractice refer to specific legal terms that do not have any bearing on this medication scenario.)

Jonas is a 29-year-old patient with anxiety and a history of alcohol abuse who is an inpatient on the psychiatric unit. He becomes angry and aggressive, strikes another patient, and then attacks a staff member. He is taken to seclusion and medicated with haloperidol and lorazepam. In this case, the haloperidol and lorazepam may be considered: 1. a restraint. 2. a medication time-out. 3. false imprisonment. 4. malpractice.

2 (Somatization is described as experiencing and expressing emotional or psychological distress as physical symptoms. Regression is a defense mechanism meaning to begin to function at a lower or previous level of functioning. Enculturation refers to how cultural beliefs, practices, and norms are communicated to its members. Assimilation refers to a situation in which immigrants adapt to and absorb the practices and beliefs of a new culture until these customs are more natural than the ones they learned in their homeland.)

Josefina Juarez, aged 36 years, comes to the mental health clinic where you work after being referred by her primary care provider. Josefina came to live in the United States from Brazil 5 years ago. She is now a single mother to 6 children, ages 2 to 15, following the death of her husband last year. During the initial intake assessment, Josefina tells you her problem is that she has headaches and backaches "almost every day" and "can't sleep at night." She shakes her head no and looks away when asked about anxiety or depression and states she does not know why she was referred to the mental health clinic. You recognize that Josefina may be exhibiting: 1. regression. 2. somatization. 3. enculturation. 4. assimilation.

Julio is a 31-year-old patient who comes to your mental health outpatient clinic. Which of the following would alert you to the potential for somatization? 1. julio states, "i have been feeling sad for weeks." 2. julio shows you bottles of medication he has been prescribed for anxiety. 3. julio presents with concerns involving headaches, dizziness, and fatigue. 4. julio states, "i have been sleeping all the time."

tertiary

Levels of prevention strategies prominent in outpatient psychiatric care consist of primary prevention, secondary prevention, and _______ prevention.

2 (Schemas are unique assumptions about ourselves, according to Beck's theory. This statement is an example of a negative schema. Emotional consequence is the end result of negative thinking process, as described by Ellis. Actualization is a level of Maslow's Hierarchy of Needs. Aversion is a therapy characterized by punishment. )

Lucas states, "I will always be alone because nobody could love me." This is most likely an example of: 1. emotional consequence. 2. schema. 3. actualization. 4. aversion.

1 (Central to Maslow's theory is the assumption that human beings are active rather than passive participants in life, striving for self-actualization. Maslow -1968- focuses on human need fulfillment, which he describes in six incremental stages, beginning with physiological survival needs and culminating in self-transcendent needs -see Figure 2-5 in the text-. Although these needs are present in all human beings, the behaviors that emanate from them differ according to a person's individual biological makeup and environmental factors. This picture is broader and more holistic. Maslow does not address moral development, the potential for success, or interactions directed toward interpersonal relationships.)

Maslow's theory of humanistic psychology has provided nursing with a framework for 1. holistic assessment. 2. determining moral development. 3. identifying the potential for success in therapy. 4. conducting nurse-client interpersonal interactions.

1 (Because most health insurance is employer based, few chronically ill clients have private insurance.)

Most clients who are diagnosed with chronic mental illness are not likely to have their psychiatric mental health experiences covered by 1. private insurance. 2. Medicare. 3. Medicaid. 4. Social Security.

2 (Eastern tradition, such as in China, where Ms. Wong is from, 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.)

Ms. Wong, aged 52 years, comes to the emergency room with severe anxiety. She was raised in China but immigrated to the United States at age 40 years. She was recently fired from her job because of a major error in the accounting department that she managed. Ms. Wong's aged parents live with her. Ms. Wong states, "I am a failure." Which of the following statements may accurately assess the basis for Ms. Wong's anxiety and feelings of failure? 1. Ms. Wong may feel that she has let herself down since she did not achieve her personal goals in the workplace. 2. Ms. Wong may feel that she has shamed the family by being fired and may no longer be able to provide for them. 3. Ms. Wong may feel personally inadequate since she failed in her quest for independence and self-reliance. 4. Ms. Wong may be feeling anxiety because in her family's traditions her failure may result in a changed fate.

Of the following environments, which would be most conducive to a therapeutic session? 1. The nurses' station 2. A table in the coffee shop 3. A quiet section of the day room 4. The utility room

1 (The nurse manager is responsible for an awareness of the safety of the unit, its effectiveness in the delivery of services, and how well the components of the health care team integrate their services.)

On a hospital inpatient unit, the nurse manager primary responsible is to 1. assure the safety of both clients and staff on the unit. 2. assist the client to prepare a support system by the time of discharge. 3. provide medication therapy for the patients on the unit. 4. help the inpatient community remain supportive of each other.

2 (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.)

One characteristic of mental health that allows people to adapt to tragedies, trauma, and loss is: 1. dependence. 2. resilience. 3. pessimism. 4. altruism.

1 (Freud's theory of the unconscious is particularly valuable as a baseline for considering the complexity of human behavior. By considering conscious and unconscious influences, a nurse can develop and begin to think about the root causes of client suffering.)

One implication of Freud's theory of the unconscious on psychiatric mental health nursing is related to the consideration that conscious and unconscious influences can help nurses better understand 1. the root causes of client suffering. 2. the client's immature behavior. 3. the client's interpersonal interactions. 4. the client's psychological ability to reason.

One of the possible sources of boundary violations is placing the focus on 1. meeting the nurse's needs. 2. identifying client disturbances. 3. assessing the client's ego strength. 4. assessing the client's weaknesses.

4 (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.)

One primary goal and benefit of Assertive Community Treatment (ACT) is: 1. forming closer relationships with the patient's family. 2. more flexible work schedule for staff. 3. more reimbursement to staff for services provided. 4. preventing rehospitalization.

classical conditioning

Pavlov formalized his observations of behaviors in dogs in a theory of _____ _____. Pavlov (1928) found that when a neutral stimulus (a bell) was repeatedly paired with another stimulus (food that triggered salivation), eventually the sound alone could elicit salivation in the dogs. These responses are involuntary - not under personal control - and are not spontaneous choices. Ex: a child becoming ill after eating spoiled coleslaw at a picnic later on feels nauseated each time he smells coleslaw.

conditioning

Pavlov's, Watson's, and Skinner's models focus on the belief that behavior can be influenced through a process referred to as ______, which involves pairing a behavior with a condition that reinforces or diminishes the behavior's occurrence.

4 (Clients with an indigenous worldview are interested in connectedness and being in harmony with others. They have little interest in personal goals and autonomy.)

People who have an indigenous worldview 1. see themselves as spiritual and believe that they are linked with all other living things. 2. focus on the articulation of individual needs and ideas. 3. view the self as an extension of cosmic energy that is repeatedly reborn. 4. are concerned with being part of a harmonious community.

Providing a safe environment for patient's with impaired cognition, planning unit activities to stimulate thinking, and including patients and staff in unit meetings are all part of: 1. milieu therapy. 2. cognitive-behavior therapy. 3. behavior therapy. 4. interpersonal psychotherapy.

mental health

Psychiatric ______ ______ nursing is defined as promoting mental health through the assessment, diagnosis, and treatment of human responses to mental health problems and psychiatric disorders.

Recent immigrants to the United States from which country would find direct eye contact a positive therapeutic technique? 1. Korea 2. Mexico 3. Japan 4. Germany

DSM-5 (diagnostic and statistical manual)

Results of epidemiological studies are routinely included in the ______ to describe the frequency of mental disorders. Analysis of such studies can reveal the frequency with which psychological symptoms appear together with physical illness. Ex: studies demonstrate that depression is a significant risk factor for death in people with cardiovascular disease and premature death in people with breast cancer.

2 (In modeling, the therapist provides a role model for specific identified behaviors, and the client learns through imitation. The therapist may do the modeling, provide another person to model the behaviors, or present a video for the purpose. Some behavior therapists use role-playing in the consulting room for modeling therapy.)

Role-playing is associated with which type of therapy? 1. Psychoanalysis. 2. Modeling. 3. Operant conditioning. 4. Systematic desensitization.

Select all that apply: A nurse stops in to interview a patient on a medical unit and finds the patient lying supine in her bed with the head elevated at 10 degrees. Which initial response(s) would most enhance the chances of achieving a therapeutic reaction? 1. apologize for the differential in heigh and proceed while standing to avoid delay. 2. if permitted, raise the head of the bed and, with the patient's permission, sit on the bed. 3. if permitted, raise the head of the bed to approximately the nurse's height while standing. 4. sit in whatever chair is available in the room to convey information and increase comfort. 5. locate a chair or stool that would place the nurse at approximately the level of the patient. 6. remain standing and proceed so as not to create distraction by altering the arrangements.

1, 2, 3, 5

Select all that apply: Gina is admitted for treatment of depression with suicidal ideation triggered by marital discord. Her spouse visits one night and informs Gina he has decided to file for divorce. The staff are aware of the visit and the husband's intentions regarding divorce but take no further action, feeling that the q15-suicide checks Gina is already on is sufficient. Thirty minutes after the visit ends, staff makes rounds and discover Gina has hanged herself in her bathroom, using hospital pajamas she had tied together into a rope. Which of the following statements best describes this situation? 1. the nurses have created a liability for themselves and their employer by failing in their duty to protect Gina. 2. the nurses have breached their duty to reassess Gina for increased suicide risk after her husband's visit. 3. given Gina's history, the nurses should have expected an increased risk of suicide after the husband's announcement. 4. the nurses correctly reasoned that suicide cannot always be prevented and did their best to keep Gina safe through checks every 15 minutes. 5. the nurses are subject to a tort of professional negligence for failing to prevent the suicide by increasing the suicide precautions in response to Gina's increased risk. 5. had the nurses restricted Gina's movements or increased their checks on her, they would have been liable for false imprisonment and invasion of privacy, respectively.

1, 2, 4, 5

Select all that apply: Which are the purposes of a thorough mental health nursing assessment? 1. establish a rapport between the nurse and patient. 2. assess for risk factors affecting the safety of the patient or others. 3. allow the nurse the chance to provide counseling to the patient. 4. identify the nurse's goals for treatment. 5. formulate a plan of care.

1, 2, 3, 4

Select all that apply: Which nursing action demonstrates cultural competence? 1. planning mealtime around the patient's prayer schedule. 2. advising a patient to visit with the hospital chaplain. 3. researching foods that a lacto-vegetarian patient will eat. 4. providing a time for a patient's spiritual healer to visit. 5. ordering standard meal trays to be delivered three times daily.

1, 3, 4, 5, 6

Select all that apply: Which of the following factors contribute to the movement of patients out of large state institutions and into community-based mental health treatment? 1. states desire to save money by moving the patients to the community, where the federal government would pick up more of the cost. 2. the growing availability of generous mental health insurance coverage gave more patients the ability to seek private care in the community. 3. a system of coordinated and accessible community care was developed by forward-thinking communities and offered more effective treatment. 4. the community mental health centers act of 1963 required states to develop and offer care in community-based treatment programs. 5. patient advocates exposed deficiencies of state hospitals and took legal actions, leading to the identification of a right to treatment in the least restrictive settings. 6. new psychotropic medications controlled symptoms more effectively, allowing many patients to live and receive care in less restrictive settings.

1, 3, 4, 6

Select all that apply: Which of the following nursing actions is appropriate in maintaining a safe therapeutic inpatient milieu? 1. interact frequently with both individuals and groups on the unit. 2. attempt to introduce patients with similar backgrounds to each other to form social bonds after discharge. 3. initiate and support group interactions via therapeutic groups and activities. 4. provide and encourage opportunities to practice social and other life skills. 5. collaborate with housekeeping to provide a safe, pleasant environment. 6. assess patient belongings and the unit for any dangerous items that could be used by patients to hurt themselves or others.

1, 2, 3, 4

Select all that apply: You are assessing a 6-year-old patient. When assessing a child's perception of a difficult issue, which methods of assessment are appropriate? 1. engage the child in a specific therapeutic game. 2. ask the child to draw a picture. 3. provide the child with an anatomically correct doll to act out a story. 4. allow the child to tell a story.

The nurse is finding it difficult to provide structure and set limits for a client. The nurse should self-evaluate for 1. boundary blurring. 2. value dissonance. 3. covert anger. 4. empathy.

2 (A patient may be medicated against his or her will without a court hearing in an emergency if the patient poses a danger to himself or herself or to others. The other options are not legally valid reasons to give medication against a patient's will.)

Sophie, aged 27 years, has a diagnosis of paranoid schizophrenia. She stopped taking her medications and believes that she is to be taken by the aliens to live with them on another planet. She was observed walking through traffic on a busy road, and then was found climbing the railing on a bridge, to "be ready for them to take me in their ship." Sophie is hospitalized. During your shift she begins running up and down the halls, banging her head on the walls, and yelling, "Get them out of my head!" On what basis can Sophie be medicated against her will? 1. If Sophie has taken the medication in the past and has had no adverse effects 2. If Sophie may cause imminent harm to herself or others 3. If Sophie still has the capacity to make an informed decision regarding medication 4. If Sophie is provided education regarding the medication before administration of the medication

security operation

Sullivan coined the term _____ _____ to describe measures the individual employs to reduce anxiety and enhance security. Collectively, all of these an individual uses to defend against anxiety and ensure self-esteem make up the self-system.

participant observer

Sullivan first used the term ______ ______, which underscores that professional helpers cannot be isolated from the therapeutic situation if they are to be effective. Sullivan would insist that the nurse interact with the patient as an authentic human being. Mutuality, respect for the patient, unconditional acceptance, and empathy, which are considered essential aspects of modern therapeutic relationships, were important aspects of Sullivan's theory of interpersonal therapy.

3 (According to Sullivan, the purpose of all behavior is to get needs met through interpersonal interactions and decrease or avoid anxiety. He viewed anxiety as a key concept and defined it as any painful feeling or emotion arising from social insecurity or blocks to getting biological needs satisfied.)

Sullivan viewed anxiety as 1. emotional experience felt after the age of 5 years. 2. a sign of guilt in adults. 3. any painful feeling or emotion arising from social insecurity. 4. adults trying to go beyond experiences of guilt and pain.

2 (Both Sullivan and Freud coined terms to mean actions that individuals do that are an attempt to reduce anxiety. The terms to do not refer to activities that increase self-esteem. Security operations and defense mechanisms are not conscious and therefore do not increase self-awareness. These terms do not refer to reducing cognitive distortions.)

Sullivan's term security operations and Freud's term of defense mechanisms both reflect actions that serve to: 1. increase self-esteem. 2. reduce anxiety. 3. increase self-awareness. 4. reduce cognitive distortions.

1, 2, 3, 4, 5

The DSM-IV-TR included a five axis system where axis ______ was the psychiatric diagnosis, axis ______ was reserved for personality disorders, axis ______ identified general medical conditions, axis _______ was environmental stressors, and axis ______ provided a tool that measured global functioning with a specific number from 0-100.

2 (The Eastern traditional world view is sociocentric. Individuals experience their selfhood and their lives as part of an interdependent web of relationships and expectations.)

The Eastern world view can be identified by the belief that 1. one's identity is found in individuality. 2. holds responsibility to family as central. 3. time waits for no one. 4. disease is a lack of harmony with the environment.

NOC (nursing outcomes classification)

The ______ is a comprehensive source of standardized outcomes, definitions of these outcomes, and measuring scales that help to determine the outcome of nursing interventions.

NIC (nursing interventions classification)

The ______ is a tool used to standardize, define, and measure nursing care.

basic

The ______ level of psychiatric nursing practice includes RN's and coordinates care, teaches about and promotes health, practives milieu (watching everything that goes on in the environment to make sure it's okay), pharmacological, biological, and integrative therapies, and can counsel but cannot provide consultation.

advanced

The ______ level of psychiatric nursing practice includes includes NP, DNP, and CNS and provides all activities of basic levels of nursing as well as medication prescription and treatment, psychotherapy, and consultation.

1 (The goal of managed care is to provide coordination of all health services with an emphasis on preventive care.)

The case manager is demonstrating an understanding of the primary goals of managed care when 1. arranging for the client to have a screening for prostate cancer. 2. notifying the family that the client will require a wheelchair when discharged. 3. providing the client with organizations that help defray the cost of prescribed drug. 4. arranging for respite care when the client's family needs to attend an out-of-state affair.

1 (Behaving as a wise and prudent person would act under the same circumstances is one way of judging whether the standard of care has been violated. Employers typically hope that staff will prevent clients from striking each other.)

The charge nurse shares with the psychiatric technician that negligence of a patient 1. is an act or failure to act in a way that a responsible employee would act. 2. applies only when the client is abandoned or mistreated. 3. is an action that puts the client in fear of being harmed by the employee. 4. means the employee has given malicious false information about the client.

1 (Civil rights are not lost because of hospitalization for mental illness.)

The civil rights of persons with mental illness who are hospitalized for treatment are 1. the same as those for any other citizen. 2. altered to prevent use of poor judgment. 3. always ensured by appointment of a guardian. 4. limited to provision of humane treatment.

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

The 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 1. refrain from attempting suicide. 2. be placed on suicide precautions. 3. attend self-help group daily. 4. state absence of feelings of powerlessness.

4 (At the time the community mental health movement began, relatively few advanced practice psychiatric nurses were practicing, and fewer still were prepared to care for the mentally ill in the community.)

The community mental health movement was least influenced by 1. the advent of antipsychotic medications. 2. increasing public awareness of the poor care given in some large psychiatric hospitals. 3. the proliferation of federal entitlement programs, making it possible to move the mentally ill out of hospitals. 4. the increasingly larger numbers of advanced practice nurses prepared to care for the mentally ill in the community.

1 (Repeated studies have shown that people with mental illnesses also have a higher risk for medical disorder than the general population.)

The community mental health nurse recognizes that the mentally ill population will require 1. frequent assessment for physical illness both acute and chronic in nature. 2. continuous supervision in order to assure that their physical needs are met. 3. government assistance in the form of health insurance and housing. 4. legal assistance to ensure they retain their civic rights.

The concepts at the heart of Sullivan's theory of personality are: 1. needs and anxiety. 2. basic needs and meta-needs. 3. schemas, assimilation, and accommodation. 4. developmental tasks and psychosocial crises.

The criteria for admission to an in patient psychiatric unit is that the patient: 1. refuses to comply with the treatment term in regard to medication, counseling, living situation, or substance abuse abstinence. 2. is in imminent danger of harming himself or others, or the patient cannot properly care for his basic needs and cannot protect himself from harm. 3. refuses are psychotropic medication. 4. is court-ordered by a judge specializing in mental health.

diathesis, stress

The diathesis-stress model, in which the _______ represents biological predisposition and _______ represents environmental stress or trauma, is the most accepted explanation for mental illness. This nature-plus-nurture argument asserts that most psychiatric disorders result from a combination of genetic vulnerability and negative environmental stressors.

defense mechanisms

The ego develops ______ ______ to ward off anxiety by preventing conscious awareness of threatening feelings. They share two common features: they all (except suppression) operate on an unconscious level and they deny, falsify, or distort reality to make it less threatening. Although we cannot survive without these, it is possible for them to distort reality to such a degree that we experience difficulty with healthy adjustment or personal growth.

The intervention that can be practiced by an advance practice registered nurse in psychiatric mental health but cannot be practiced by a basic level registered nurse is: 1. advocacy. 2. psychotherapy. 3. coordination of care. 4. community-based care.

3 (Each nurse's practice is governed by the Nurse Practice Act of the state in which the nurse practices. The nurse should always be aware of its provisions.)

The intervention that will be most effective in preventing a nurse from making decisions that will lead to legal difficulties is 1. asking a peer to review nursing intervention related decisions. 2. balancing the rights of the client and the rights of society. 3. maintaining currency in state laws affecting nursing practice. 4. seeking value clarification about fundamental ethical principles.

1 (General assessment of clients in the community is expanded to include community living challenges and resources, the client's ability to cope with the demands of living in the community, and the client's willingness to accept community support.)

The major difference between the psychiatric nursing assessment performed for a client who is hospitalized and for a client who will be treated in the community is 1. for the latter, the general assessment must be expanded. 2. for the latter, the nursing focus is primarily on the mental status examination. 3. for the former, the general assessment must be reimbursement based. 4. for the former, the nursing focus is limited to the client's willingness to accept treatment.

3 (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.)

The mental health status of a particular client can best be assessed by considering 1. the degree of conformity of the individual to society's norms. 2. the degree to which an individual is logical and rational. 3. placement on a continuum from health to illness. 4. the rate of intellectual and emotional growth.

The mental status examination aids in the collection of what type of data? 1. Covert 2. Physical 3. Objective 4. Subjective

1 (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.)

The most likely factor to interfere with data collection in an initial assessment interview of an older adult is 1. whether the client has any physical deficiencies. 2. the interviewing nurse's level of anxiety. 3. the presence of any countertransference. 4. the nurse's attitudes about aging.

1 (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.)

The nurse assesses the wellness beliefs and values of a client from another culture best when asking 1. "What do you think is making you ill?" 2. "When did you first feel ill?" 3. "How can I help you get better?" 4. "Did you do something to cause the illness?"

The nurse best assesses the client's spiritual life by asking, 1. "Do you practice a specific religion?" 2. "To whom do you turn in times of crisis?" 3. "Do you attend church regularly?" 4. "What role does religion play in your life?"

3 (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.)

The nurse best ensures appropriate client care when choosing an intervention from a Nursing Interventions Classification that matches both 1. the condition's etiology and the client's symptomatology. 2. the nursing diagnosis and the condition's etiology. 3. the defining data and the nursing diagnosis. 4. the medical diagnosis and the nursing diagnosis.

The nurse is planning care for a Latin American patient. Which goal is appropriate? 1. patient will visit with spiritual healer once weekly. 2. patient will experience rebalance of yin-yang by discharge. 3. patient will identify sources that create "cold wind" within 24 hours of admission. 4. patient will contact "singer" to provide healing rituals within 3 days of admission.

1 (Maslow describes safety as a basic need, meaning that it is so basic to existence that it must be resolved to reduce the tension associated with it. These needs have the greatest strength and must be satisfied before a person turns his attention to higher-level needs.)

The nurse is working with a client experiencing both post-partum depression and very low self-esteem. The client is distrustful of unit staff and "just wants to go home." Initially the nurse's priority is to 1. establish trust with the client. 2. teach the client effective mothering skills. 3. identify positive traits the client possesses. 4. focus on preparing for a speedy discharge.

3 (According to Erikson, the task of adolescence is to achieve identity rather than to be left in role confusion. A sense of identity is essential to making the transition into adulthood.)

The nurse planning care for a 14-year-old needs to take into account that the developmental task of adolescence is to 1. establish trust. 2. gain autonomy. 3. achieve identity. 4. develop a sense of industry.

1 (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.)

The nurse planning care for a mentally ill client bases interventions on the concept that the client 1. has areas of strength on which to build. 2. has right that must be respected. 3. comes with experiences that contribute to their problem. 4. share fears that are similar to those of all mentally healthy individuals.

4 (Ignoring the tantrum provides no reinforcement of the undesirable behavior. Instead, approval and reinforcement are given when the child is behaving in the desired way. This is an example of absence of reinforcement, or extinction.)

The nurse providing anticipatory guidance to the mother of a toddler should advise that childhood temper tantrums are best handled by 1. giving the child what he is asking for. 2. scolding the child when he displays tantrum behaviors. 3. spanking the child at the onset of the tantrum behaviors. 4. ignoring the tantrum and giving attention when the child acts appropriately.

2 (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 nurse who provides therapeutic milieu management supports the clients best by 1. allowing them to act out their fears and frustrations. 2. providing a safe place for them to practice coping skills. 3. meeting their physical as well as emotional needs. 4. encouraging them to talk about their problems with others.

The nurse would NOT address which of the following goals in attempting to establish a therapeutic nurse-client relationship? 1. Assisting the client with self-care needs when appropriate. 2. Helping the client identify self-defeating behaviors. 3. Providing the client with opportunities to socialize. 4. Facilitating the client's communication of disturbing feelings or thoughts. Encouraging the client to make decisions when appropriate.

The orientation phase of the nurse-client relationship focuses on 1. the nurse identifying personal biases. 2. the nurse and client identifying client needs. 3. overcoming resistance to changing behavior. 4. reviewing situations that occurred in previous meetings.

The outcome of the nurse's expressions of sympathy instead of empathy toward the client often leads to 1. enhanced client coping. 2. lessening of client emotional pain. 3. increased hope for client improvement. 4. decreased client communication.

The phase of the nurse-client relationship that may cause anxieties to reappear and past losses to be reviewed is the 1. preorientation phase. 2. orientation phase. 3. working phase. 4. termination phase.

The pre-orientation phase of the nurse-client relationship is characterized by the nurse's focus on 1. self-analysis of strengths, limitations, and feelings. 2. clarification of the nursing role. 3. changing the client's dysfunctional behavior. 4. incorporating coping skills into client's routine.

2 (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.)

The preferred seating arrangement for a nurse-client interview is with 1. the nurse behind a desk and the client in a chair in front of the desk. 2. the nurse and client sitting at a 90-degree angle to each other. 3. the client sitting in a chair and the nurse standing a few feet away. 4. the nurse and client sitting facing each other.

The premise that an individual's behavior and affect are largely determined by his or her attitudes and assumptions about the world underlies: 1. modeling. 2. milieu therapy. 3. cognitive-behavioral therapy. 4. psychoanalytical psychotherapy.

1 (The premise underlying behavior therapy is that behavior is learned and can be modified. Behaviorists agree that behavior can be changed without insight into the underlying cause.)

The premise underlying behavioral therapy is 1. Behavior is learned and can be modified. 2. Behavior is a product of unconscious drives. 3. Motives must change before behavior changes. 4. Behavior is determined by cognitions; change in cognitions produces new behavior.

4 (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 prevalence rate over a 12-month period for major depressive disorder is 1. lower than the prevalence rate for panic disorders. 2. greater than the prevalence rate for psychotic disorders. 3. equal to the prevalence rate for psychotic disorders. 4. greater than the prevalence rate for generalized anxiety.

2 (Case management coordinates and monitors the effectiveness of services appropriate for the client. In the community setting, for example, close monitoring permits rapid assessment of the need for crisis intervention to avoid costly readmission.)

The primary advantage of using a case manager is to 1. increase collaborative practice. 2. enhance resource management. 3. increase client satisfaction with care. 4. promote evidence-based psychiatric nursing.

The primary difference between a social and a therapeutic relationship is the 1. type of information exchanged. 2. amount of satisfaction felt. 3. type of responsibility involved. 4. amount of emotion invested.

1 (The client should always be considered the primary data source. At times, however, the client will be unable to fulfill this role.)

The primary source for data collection during a psychiatric nursing assessment is the 1. client's own words and actions. 2. client's family and friends. 3. client's nonverbal responses. 4. client's medical treatment records.

1 ( The nurse and the client should work collaboratively because each has knowledge to contribute to planning for the attainment of mutually derived outcomes.)

The principle that is the basis of nursing outcome planning is 1. individuals have the right to autonomy to make decisions that affect them. 2. nursing interventions are designed to solve individuals' problems for them. 3. the goal of nursing action is to create a dependency between the client and the caregiver. 4. nurses have the best understanding of client problems and so they direct outcome selection.

3 (Primary prevention is directed at healthy individuals with the purpose of preventing mental illness.)

The psychiatric community health nurse engages in primary prevention when 1. visiting a homeless shelter to provide crisis intervention for its clients. 2. discussing the need for proper nutrition with a depressed new mother. 3. providing stress reduction seminars at the local senior center. 4. visiting the home of a client currently displaying manic behavior.

The psychiatric mental health nurse working with depressed clients of the Eastern culture must realize that a useful outcome criterion might be if client reports 1. increased somatic expressions of distress. 2. disruption of energy balance. 3. appeasement of the spirits. 4. increased anxiety.

1 (In most cultures a holistic perspective prevails, one without separation of mind and body.)

The psychiatric nurse planning and implementing care for culturally diverse clients should understand 1. holistic theory. 2. systems theory. 3. adaptation theory. 4. political power theory.

4 (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.)

The quantitative study of the distribution of mental disorders in human populations is called 1. mortality. 2. prevalence. 3. epidemiology. 4. clinical epidemiology.

The question that would give data of least value to the assessment of family dynamics is 1. "What changes have occurred recently at work?" 2. "Are your wife and children conforming to your expectations?" 3. "Are you experiencing stress associated with conforming to family expectations?" 4. "Do you expect others to shun or avoid you because you are seeing a therapist?"

ethics

The study of philosophical beliefs about what is considered right or wrong in a society:

bioethics

The study of specific ethical questions that arise in health care. Divided into 5 basic principles: beneficence, autonomy, justice, fidelity, veracity.

bioethics

The term ____ is used in relation to ethical dilemmas surrounding healthcare.

The theory of interpersonal relationships developed by Hildegard Peplau is based on the foundation provided by which early theorist? 1. Freud. 2. Piaget. 3. Sullivan. 4. Maslow.

The use of empathy and support begins in the stage of the nurse-client relationship termed the 1. orientation stage. 2. working stage. 3. identification stage. 4. resolution stage.

1 (Autonomy refers to self-determination and beneficence refers to doing good. When a client is restrained or secluded, the need to do good and prevent harm outweighs the client's autonomy.)

The use of seclusion or restraint to control the behavior of a client who is at risk of harming self or others gives rise to conflict between the ethical principles of 1. autonomy and beneficence. 2. advocacy and confidentiality. 3. veracity and fidelity. 4. justice and humanism.

4 (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.)

There is one bed on a locked psychiatric unit. Which of the following patients is appropriate for involuntary admission? 1. Jill, aged 23 years, a college student who has developed symptoms of anxiety and is missing classes and work 2. Michael, aged 30 years, an accountant who has developed symptoms of depression 3. Mia, aged 26 years, a kindergarten teacher who is not in touch with reality and was found wandering in and out of traffic on a busy road 4. Rose, aged 76 years, a retired librarian who is experiencing memory loss and some confusion at times

These severe mental illnesses are recognized across cultures: 1. antisocial and borderline personality disorders. 2. schizophrenia and bipolar disorder. 3. bulimia and anorexia nervosa. 4. amok and social phobia.

To help a client develop his or her resources, the nurse must first be aware of 1. the client's strengths. 2. negative transferences. 3. countertransferences. 4. resistances.

mental health

Traits of _____ _____ include the ability to think rationally, communicate appropriately, learn, grow emotionally, be resilient, and have a healthy self-esteem.

true

True/False: Mental illness is culturally defined and there is no standard measure. For example: in parts of Southeast Asia suffer from a syndrome called "running amok", in which the person, usually male, runs around engaging in almost indiscriminate violent behavior. In colder regions people suffer from an uncontrollable desire to tear off one's clothing and run naked (pibloktoq) exposing themselves to the harsh cold.

2 (The value of Maslow's model in nursing practice is twofold. First, the emphasis on human potential and the client's strengths is key to successful nurse-client relationships. The second value lies in establishing what is most important in sequencing of nursing actions in the nurse-client relationship.)

Using Maslow's model of needs, the nurse providing care for an anxious client identifies the priority intervention to be 1. assessing the client's success at fulfilling her appropriate developmental level tasks. 2. assessing the client for her strengths upon which a nurse-client relationship can be based. 3. planning one-on-one time with the client to assist in identifying the fears behind her anxiety. 4. evaluating the client's ability to learn and retain essential information regarding her condition.

4 (Involuntary admission implies that the client did not consent to the admission. The usual reasons for admitting a client over his or her objection is if the client presents a clear danger to self or others or is unable to meet even basic needs independently.)

What assumption can be made about the client who has been admitted on an involuntary basis? 1. The client can be discharged from the unit on demand. 2. For the first 48 hours, the client can be given medication over objection. 3. The client has agreed to fully participate in treatment and care planning. 4. The client is a danger to self or others or unable to meet basic needs.

2 (Autonomy refers to self-determination. One way to exercise self-determination is to make decisions about one's care.)

What ethical principle is supported when a nurse witnesses the informed consent for electroconvulsive therapy from a depressed client? 1. Beneficence 2. Autonomy 3. Justice 4. Fidelity

What is the common behavior shared by both client and nurse at the beginning of the initial assessment interview? 1. Anxiety 2. Biased perceptions 3. Countertransference 4. Reliance on supportive confrontation

DSM-5

What is the official guideline for diagnosing psychiatric disorders?

What therapeutic communication technique is the nurse using by asking a newly admitted patient, "Can you tell me what was happening to you that led to your being hospitalized here?" 1. Using a minimal encourager 2. Using an open-ended question 3. Paraphrasing 4. Reflecting

What three structural components comprise a nursing diagnosis? 1. Problem, outcome, intervention 2. Problem, etiology, supporting data 3. Unmet need, goal, outcome criterion 4. Presenting symptom, treatment, goal

CBT (aaron beck)

What type of therapy is based on the underlying theoretical principle that feelings and behaviors are largely determined by the way people think about the world and their place in it. Their cognitions (verbal or pictorial events in their stream of consciousness) are based on attitudes or assumptions developed from previous experiences. These cognitions may be fairly accurate, or they may be distorted.

When a nurse and client meet informally or have an otherwise limited but helpful relationship, the relationship is referred to as a(n) 1. crisis intervention. 2. therapeutic encounter. 3. autonomous interaction. 4. preorientation phenomenon.

When a nurse is biased against a client, those feelings will likely make it difficult to 1. assess the client's symptoms. 2. assess boundary issues with the client. 3. view the client with positive regard. 4. engage in values clarification with the client.

3 (Clients are referred to the clinic program for long-term follow-up from inpatient units or other providers or outpatient care. The treatment can last for years, and discharge is achieved when improvement is shown or desired outcomes are reached.)

When asked to explain what a psychosocial rehabilitation program is, the nurse responds best when sharing 1. "The concept started in the 1960s and provides psychiatric care for those without private insurance." 2. "The individual program can provide medication, therapies, and social services for the mentally ill." 3. "Referrals from inpatient and intensive outpatient facilities are provided with long-term care that focuses on desired goals." 4. "It is a multidisciplinary team approach that is composed of nurses, psychiatrics, social workers, and psychologists."

2 (At birth we are all id. The id is the source of all drives, instincts, reflexes, needs, genetic inheritance, and capacity to respond as well as all the wishes that motivate us.)

When asked, the nurse explains that a client's id is 1. the control over the emotional frustration he feels over the loss of his job. 2. the source of his instincts to save himself from hurting himself. 3. not in place since he was abused after the age of 5 months. 4. able to differentiate his believed experiences and reality.

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 1. supernatural causes. 2. negative forces. 3. inheritance. 4. imbalance.

3 (he verbal message is sometimes referred to as the content of the message, and the nonverbal behavior is called the process of the message.)

When considering the interaction between verbal and nonverbal communication, what is the best word to complete this analogy: Verbal communication relates to content as nonverbal communication relates to 1. touch. 2. conflict. 3. process. 4. double messages.

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?" 1. Focusing 2. Restating 3. Reflection 4. Clarification

1 (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.)

When interviewing an adolescent client, the nurse can expect the client to be most concerned about the issue of 1. confidentiality. 2. sexual orientation. 3. substance use or abuse. 4. family mental problems.

3 (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.)

When members of a group are introduced to the culture's worldview, beliefs, values, and practices, it is called 1. acculturation. 2. ethnocentrism. 3. enculturation. 4. cultural encounters.

4 (In the community setting treatment goals and interventions directed at long-term function within the community are negotiated rather than imposed on the client.)

When mental health care is provided for in a community setting, goal setting is 1. client-directed and focused on the individual's expressed wishes. 2. society-driven and focused on returning the client into the social community. Incorrect 3. determined by the care provider and focused on cost-effective measures. 4. negotiated by both client and staff and focused on long-term functioning.

2 (The community mental health movement began as a result of legislation passed during the Kennedy administration.)

When preparing an education program focused on the history of the community mental health movement in the United States, the nurse includes the fact that 1. use of community settings began after World War II with the discharge of large numbers of veterans with mental illness. 2. the shift from care in psychiatric hospitals to community mental health centers began in the 1960s. 3. movement of services out of hospitals and into the community is a baby-boomer phenomenon that began in the 1980s. 4. the community mental health movement is an outgrowth of managed care's response to rising health care costs beginning in the 1990s.

3 (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.)

When the client sits about 5 feet away from the nurse during the assessment interview, the nurse interprets that the client views the nurse as a 1. safe person to interact with. 2. new friend. 3. stranger. 4. peer.

3 (Voluntary admission occurs when the client is willing to be admitted and agrees to comply with hospital and unit rules.)

When the nurse reads the medical record and learns that a client has agreed to receive treatment and abide by hospital rules, the correct assumption is that the client was admitted 1. per legal requirements. 2. for a non-emergency. 3. voluntarily. 4. involuntarily.

1 (Psychiatric case management fosters success in all aspects of community living by supporting recovery from acute symptoms, reducing recidivism, and enhancing the quality of life for the client with long-term illness.)

Which activity best exemplifies the focus for a case manager? 1. Arranging for rapid assessment of a newly hospitalized client 2. Providing a comprehensive client social history to the treatment team 3. Writing a report describing best practices in care for clients with depression 4. Gathering data for a research study concerning side effects of a new medication

4 (At an initial assessment, no interventions would have taken place; hence evaluation is not a purpose of the initial contact.)

Which activity is NOT considered a purpose of the initial psychiatric assessment? 1. Obtaining understanding of the current problem 2. Identifying treatment goals 3. Formulating a plan of care 4. Evaluating the results of intervention

3 (For hospitalized clients, the treatment team does not have to worry about whether the client has a clean, safe place to stay and adequate food to eat. For the client receiving care in the community, these are legitimate planning concerns.)

Which assessment information is uniquely important to the mental health client receiving outpatient care? 1. Mental status examination results 2. The client's strengths and deficits 3. Housing adequacy and stability 4. The presenting problem and referring party

2 (Asking about typical treatment seeks information about the "usual" cultural treatment of the disorder experienced by the client.)

Which assessment question would produce data that would help a nurse understand healing options acceptable to a client of a different culture? 1. "Is there someone in your community who usually cures your illness?" 2. "What usually helps people who have the same type of illness you have?" Correct 3. "What questions would you like to ask about your condition?" 4. "What sorts of stress are you presently experiencing?"

2 (Community mental health nurses need to have a calm, nonreactive, nonjudgmental manner. Reactivity often gives clues to the nurse's inner feelings, producing situations in which the nurse does not appear to be objective.)

Which attribute would be least helpful for a community mental health nurse to have? 1. Flexibility 2. Reactive manner 3. Nonjudgmental attitude 4. Ability to cross service systems

3 (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.)

Which branch of epidemiology is the nurse involved in when seeking outcomes for patients whose depression was treated with electroconvulsive therapy (ECT)? 1. experimental 2. descriptive 3. clinical 4. analytic

4 (Interpersonal therapy is considered to be effective in resolving problems of grief, role disputes, role transition, and interpersonal deficit.)

Which client problem would be most suited to the use of interpersonal therapy? 1. Disturbed sensory perception 2. Impaired social interaction 3. Medication noncompliance 4. Dysfunctional grieving

Which communication techniques should the nurse use with a client who has been identified as having difficulty expressing thoughts and feelings? 1. Using emotionally charged words and gestures 2. Offering opinions and avoiding periods of silence 3. Asking closed-ended questions requiring "yes" or "no" answers 4. Asking open-ended questions and seeking clarification

Which contribution to modern psychiatric mental health nursing practice was made by Freud? 1. the theory of personality structure and levels of awareness. 2. the concept of a self-actualized personality. 3. the thesis that culture and society exert significance influence on personality. 4. provision of a developmental model that includes the entire life span.

4 (Although expense should be considered, interventions are chosen based on the other options and not on their economic value.)

Which criterion is NOT essential when the nurse plans nursing interventions designed to meet a specific goal? 1. Safe 2. Evidence based 3. Individualized 4. Economical

3 (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)

Which criterion must be met to refer a client to a partial hospitalization program? 1. The client is hospitalized at night in an inpatient setting. 2. The client must be able to provide his or her own transportation daily. 3. The client is able to return home each day. 4. The client is able to care for his or her own physical and psychological needs.

2 (Autonomy refers to self-determination, or the right to make one's own decisions.)

Which ethical principle refers to the individual's right to make his or her own decisions? 1. Beneficence 2. Autonomy Correct 3. Veracity 4. Fidelity

4 (The best treatment perspectives of various cultures include regaining lost balance and harmony. This perspective is not used in Western culture.)

Which healing practice is least used in the Western health system of healing practices? 1. Antibiotic medication 2. Surgery 3. Targeted cellular destruction 4. Restoring lost balance or harmony

1 (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.)

Which idea held by the nurse would best promote the provision of culturally competent care? 1. Western biomedicine is one of several established healing systems. 2. Some individuals will profit from use of both Western and folk healing practices. 3. Use of cultural translators will provide valuable information into health-seeking behaviors. Incorrect 4. Need for spiritual healing is a concept that crosses cultural boundaries.

1 (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.)

Which is a characteristic of a therapeutic inpatient milieu? 1. It provides for the client's safety and comfort. 2. Voluntarily admitted clients are generally allowed additional privileges. 3. Rules and behavioral limits are flexibly enforced. 4. Staff provide frequent and ongoing negative feedback to clients.

1 (After basic life necessities have been met, maintenance of the medication regimen is critical to preventing relapse and recurrence of the client's illness. If the client does not have access to medication, he or she will be unable to be compliant.)

Which need is the highest priority for a seriously and persistently ill client living in the community? 1. Access to medication 2. Socialization and diversion 3. Independent decision making 4. Engaging in meaningful work

Which nursing diagnosis for a psychiatric client is correctly structured and worded? 1. Hopelessness related to severe chronic depression 2. Spiritual distress as evidenced by client stating "God has abandoned me because I'm a bad person" 3. Defensive coping related to lack of insight associated with illicit drug use 4. Imbalanced nutrition: less than body requirements related to poor self-concept as evidenced by reporting "I'm not worthy of eating"

3 (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.)

Which of the following best demonstrates parity related to mental health care? 1. The client is admitted for a 72-hour mental hygiene evaluation. 2. Advance practice nurse can be certified as psychiatric nurse specialist. 3. A client's mental health coverage is equal to his medical/surgical coverage. Correct 4. A client who has attempted sucide is hospitalized for a mental health evaluation.

3 (Cultural competence means that nurses adjust and conform to their patients' cultural needs, beliefs, practices, and preferences rather than their own. This option does not describe cultural competence. Although nurses are continually learning regarding culture, it is a career-long process. The goal is not to educate patients about our own culture but rather to adjust to their cultural preferences. Although nurses may take continuing education regarding culture, this does not describe the term cultural competence. The other options do not describe cultural competence.)

Which of the following best explains the concept of cultural competence? 1. Nurses have enough knowledge about different cultures to be assured they are delivering culturally sensitive care. 2. Nurses are able to educate their patients from other cultures appropriately about the cultural norms of the United States. 3. Nurses adjust their own practices to meet their patients' cultural preferences, beliefs, and practices. 4. Nurses must take continuing education classes on culture in the process of becoming culturally competent.

Which of the following best represent the basis or foundation of all other psychiatric nursing care? 1. the nurse assesses the patient at regular intervals. 2. the nurse administers psychotropic medications. 3. the nurse spends time sitting with a withdrawn patient. 4. the nurse participates in team meetings with other professionals.

2 (B. F. Skinner -1904-1990- represented the second wave of behavioral theorists and is recognized as one of the prime movers behind the behavioral movement.)

Which of the following is considered a primary behavioral theorist? 1. Freud. 2. Skinner. 3. Sullivan. 4. Peplau.

1 (Against medical advice discharges are sometimes used when the patient does not agree with the provider, as long as the patient is not a danger to himself or herself or to others. The patient with dementia and the patient who is actively suicidal would pose a safety risk and would be not allowed to be discharged AMA. A patient who wishes to stay in the hospital can make that decision; a family member's opinion doesn't impact an AMA discharge.)

Which of the following patients may be an appropriate candidate for a release from hospitalization known as against medical advice (AMA)? 1. 37-year-old patient hospitalized for 6 days; the provider feels one more day would benefit the patient, but the patient doesn't agree and wishes to be discharged 2. 75-year-old patient with dementia who demands to be allowed to go back to his own home 3. 21-year-old actively suicidal patient on the psychiatric unit who wants to be discharged to home and do outpatient counseling 4. 32-year-old female patient who wishes to stay in the hospital but whose husband demands that she be discharged into his care

2 (PHP is for patients who may need a "step-down" environment from inpatient status or for those who are being diverted from hospitalization with intensive, short-term care from which they return home each day. This patient would be a good candidate after completing alcohol rehab; PHP could possibly help prevent relapse in the early stages after rehab. This patient can be managed with regular outpatient therapy and does not need intensive short-term therapy such as PHP. Someone who is suicidal would require inpatient hospitalization for safety as would someone who is decompensated and not caring for herself. A patient exhibiting mild depression would be managed with outpatient therapy and would not need intensive short-term therapy such as PHP.)

Which of the following patients would be appropriate to refer to a partial hospitalization program (PHP)? 1. Ramon, who is suicidal with a plan 2. Marty, a substance abuser who is being discharged from an inpatient alcohol rehabilitation unit 3. Ellen, who stopped taking her antipsychotic medication and is decompensated and not caring for herself 4. Jeff, who has mild depression symptoms and is starting outpatient therapy

Which of the following scenarios describe a HIPAA violation? 1. Janie, the ED nurse, gives report to Amanda, a nurse on the intensive care unit, regarding Joel, who is being admitted. 2. Mark, a nurse on the medical-surgical floor, calls his patient's primary care provider to obtain a list of current medications. 3. Lyla, a nurse on the cardiac unit, gives report to Chloe, the nurse on the step-down unit, regarding the patient Lyla, who will be transferring, while they are walking in the hospital hallway. 4. Tony, a nurse on the psychiatric unit, gives discharge information to the counseling office where his patient will be going to outpatient treatment after discharge.

1, 3, 4

Which of the following statements are true regarding the differences between a social relationship and a therapeutic relationship? (select all that apply): 1. In a social relationship, both parties' needs are met; in a therapeutic relationship only the patient's needs are to be considered. 2. 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. 3. Giving advice is done in social relationships; in therapeutic relationships giving advice is not usually therapeutic. 4. 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. 5. 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.

1, 3, 4, 5

Which of the following statements indicate a NONtherapeutic communication technique? (select all that apply): 1. "Why didn't you attend group this morning?" 2. "From what you have said, you have great difficulty sleeping at night." 3. "What did your boyfriend do that made you leave? Are you angry at him? Did he abuse you in some way?" 4 "If I were you, I would quit the stressful job and find something else." 5 "I'm really proud of you for the way you stood up to your brother when he visited today." 6. "You mentioned that you have never had friends. Tell me more about that." 7. "It sounds like you have been having a very hard time at home lately."

1 (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.)

Which of the following structural safety precautions is most important to prevent the most common type of inpatient suicides? 1. Break-away closet bars to prevent hanging 2. Bedroom and dining areas with locked windows to prevent jumping 3. Double-locked doors to prevent escaping from the unit 4. Platform beds to prevent crush injuries

4 (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.)

Which response to a patient's question of why you need to conduct an assessment interview best explains its purpose? 1. "I need to find out more about you and the way you think in order to best help you." 2. "The assessment interview lets you have an opportunity to express your feelings." 3. "You are able to tell me in detail about your past so that we can determine why you are experiencing mental health alterations." 4. "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."

3 (Before being given medication, the client should be fully informed about the reason for, the expected outcomes of, and any side effects of the medication. The client has the right to refuse medication. If, in a nonemergency situation, he is given medication after refusing it, his right to informed consent has been violated.)

Which right of the client has been violated if he is medicated without being asked for his permission? 1. Right to dignity and respect 2. Right to treatment 3. Right to informed consent 4. Right to refuse treatment

4 (In the inpatient setting, case managers on the hospital team communicate daily or weekly with the client's insurer and provide the treatment team guidance regarding the availability of resources. In the community, multiple levels of intervention are available within case management service, ranging from daily assistance with medications to ongoing resolution of housing and financial issues.)

Which situation demonstrates the nurse functioning in the role of advocate? 1. Providing one-to-one supervision for a client on suicide precautions 2. Co-leading a medication education group for clients and families 3. Attending an inservice education program to obtain recertification in cardiopulmonary resuscitation 4. Negotiating with the client's HMO for extension of a 3-day hospitalization to 5 days

3 (Rituals, cleansings, prayer, and even witchcraft may be the treatment expectation of a client who believes his illness is caused by spiritual forces.)

Which source of healing might be most satisfactory to a client who believes his illness is caused by spiritual forces? 1. Acupuncture 2. Dietary change 3. Cleansings 4. Herbal medicine

2 (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.)

Which statement about diagnosis of a mental disorder is true? 1. The symptoms of each disorder are common among all cultures. 2. Culture may cause variations in symptoms for each clinical disorder. 3. All mental disorders listed in the DSM-5 are seen in all other cultures. 4. Psychiatric diagnoses are listed in separately from other physical disorders in a five axes system.

Which statement about mental illness is true? 1. mental illness is a matter of individual nonconformity with societal norms. 2. mental illness is present when individual irrational and illogical behaviors occur. 3. mental illness changes with time in history, culture, political system, and the groups defining it. 4. mental illness is evaluated solely by considering individual control over behaviors and appraisal of reality.

Which statement about non-verbal behavior is accurate? 1. a calm expression means that the patient is experiencing low levels of anxiety. 2. patients respond more consistently to therapeutic touch that to verbal interactions. 3. the meaning of nonverbal behavior varies with cultural and individual differences. 4. eye contact is a reliable measure of the patient's degree of attentiveness and engagement.

1 (This statement reflects the larger thinking of the profession.)

Which statement best clarifies the difference between the art and the science of nursing? 1. The art is the care, compassion, and advocacy component, and the science is the applied knowledge base. 2. The art is the way in which knowledge is applied, and the science is the technological aspects of caregiving. 3. The art is the applied technology of practice, and the science is the problem-solving and teaching aspects of caregiving. 4. The art is the assessing and planning phases of the nursing process, and the science lies in implementing and evaluating.

Which statement best describes a major difference between a DSM-5 diagnosis and a nursing diagnosis? 1. there is no functional difference between the two; both serve to identify a human deviance. 2. the DSM-5 diagnosis disregards culture, whereas the nursing diagnosis takes culture into account. 3. the DSM-5 is associated with present symptoms, whereas a nursing diagnosis considers past, present, and potential responses to actual mental health problems. 4. the DSM-5 diagnosis impacts the choice of medical treatment, whereas the nursing diagnosis offers framework for identifying multidisciplinary interventions.

1 (The DSM-5 is a classification of mental disorders that includes descriptions and criteria of diagnoses.)

Which statement best describes the DSM-5? 1. It is a medical psychiatric assessment system. 2. It is a compendium of treatment modalities. 3. It offers a complete list of nursing diagnoses. 4. It suggests common interventions for mental disorders.

1 (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.)

Which statement best explains the term "worldview"? 1. Beliefs and values held by people of a given culture about what is good, right, and normal. 2. Ideas derived from the major health care system of the culture about what causes illness. 3. Cultural norms about how, when, and to whom illness symptoms may be displayed. 4. Valuing one's beliefs and customs over those of another group.

1 (Many years ago psychiatric clients were warehoused in large mental institutions, given custodial care, and rarely released into the community. As enlightenment occurred, it was determined that each client who is hospitalized has the right to receive treatment.)

Which statement concerning the right to treatment in public psychiatric hospitals is accurate? 1. Hospitalization without treatment violates the client's rights. Correct 2. Right to treatment extends only to provision of food, shelter, and safety. 3. All clients have the right to choose a primary therapist and case manager. 4. The right to treatment for hallucinations has priority over treatment for anxiety.

4 (The client's civil rights are intact, despite hospitalization. The right to communicate with those outside the hospital is ensured.)

Which statement is true regarding mail sent to an involuntarily admitted client residing on a psychiatric inpatient unit? 1. The client can receive mail from only family and legal sources. 2. Mail must first be opened and inspected by staff. 3. Receipt of mail is considered a privilege accorded the client for compliance. 4. Mail is a form of social interaction and so receiving mail is a client's civil right.

1 (The hospitalized client is not a convicted criminal. All civil rights remain intact. Patients' rights are clearly posted in all inpatient units.)

Which statement regarding clients' rights after being voluntarily admitted to a behavioral health unit is true? 1. All rights remain intact. 2. Only rights that do not involve decision making remain intact. 3. The right to refuse treatment is no longer guaranteed. 4. All rights are temporarily suspended.

Which student behavior is consistent with therapeutic communication? 1. offering your opinion when asked in order to convey support. 2. summarizing the essence of the patient's comments in your own words. 3. interrupting periods of silence before they become awkward for the patient. 4. telling the patient he did well when you approve of his actions or statements.

4 (This modification requires careful titration and observation that would be difficult to provide on an outpatient basis. Lithium toxicity can proceed to death.)

Which symptomatology has priority for admission to an inpatient behavioral health unit? 1. Severe anxiety and feeling as though one is suffocating 2. Profound grieving over the recent death of one's identical twin 3. Hearing voices that proclaim one to be "the exalted ruler of the universe" 4. History of seizures and an elevated lithium level

4 (Crises on a psychiatric unit can be either medical in nature or behavioral. Medical crises include shock, cardiopulmonary arrest, hemorrhage, and status epilepticus, whereas behavioral crises include actual or potential violence against self, others, or the environment. Option D is not considered a crisis, but rather a potential crisis that was averted.)

Which would NOT be considered a crisis on a psychiatric unit? 1. Mr. R reports chest pain after eating a spicy lunch. 2. Ms. T cannot speak and is holding her hands up to her neck. 3. Mr. S demonstrates anger that escalates to physical assault. 4. Mr. U reports hearing voices telling him to hit others.

Erikson

Who described development as occurring in eight predetermined and consecutive life stages (psychosocial crises), each of which consisted of two possible outcomes (e.g. industry vs inferiority). The successful or unsuccessful completion of each stage will affect the individual's progression to the next.

Peplau

Who shifted the focus from what nurses do to patients to what nurses do with patients (1989) that engineered a major paradigm shift from a model focused on medical treatments to an interpersonal relational model of nursing practice?

Peplau

Who viewed nursing as an educative instrument designed to help individuals and communities use their capacities in living more productively (1987)?

Peplau

Who was the first nurse to identify psychiatric mental health nursing both as an essential element of general nursing and as specialty area that embraces specific governing principles. This person was also the first nurse theorist to describe the nurse-patient relationships as the foundation of nursing practice.

Peplau (1982)

Whose theory is mainly concerned with the processes by which the nurse helps patients make positive changes in their health care status and well-being. This person also believed that illness offered a unique opportunity for experiential learning, personal growth, and improved coping strategies and that psychiatric nurses play a unique role in facilitating this growth?

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? 1. "It's good that you feel guilty. That means you still have a chance of being helped." 2. "Of course you feel guilty. You did a horrendous thing. You shouldn't even be out of prison." 3. "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." 4. "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."

With which client should the nurse make the assessment that not using touch would probably be in the client's best interests? 1. A recent immigrant from Russia 2. A deeply depressed client 3. A Chinese American client 4. A tearful client reporting pain

4 (In believing only in the biological model to the exclusion of other theories and perspectives, influences such as educational, social, spiritual, cultural, environmental, and economic are not considered, and these have also been proven to play a part in mental health and mental illness. The other options are untrue.)

You and Jack are two of the nurses working on the psychiatric unit. Jack mentions to you that the biological model for mental illness is the one he embraces, and states "it's the only one I really believe." Which of the following statements is true regarding believing in only the biological model? 1. The biological model is the oldest and most reliable model for explaining mental illness. 2. The biological model does not explain every symptom of mental illness. 3. The biological model is the most popular theory among leading psychiatrists and therefore the one that should be fully embraced. 4. In believing only the biological model, other influences on mental health including cultural, environmental, social, and spiritual influences are not taken into account.

3 (Based on Maslow's theory, physiological needs such as food, water, air, sleep, etc., are the priority and must be taken care of first. The other options are symptoms of mania but not as critical as lack of sleep.)

You are caring for Alyssa, a 28-year-old patient with bipolar disorder who was admitted in a manic state. According to Maslow's Hierarchy of Needs theory, which of the following symptoms needs to be the first priority in caring for this patient? 1. Rapid, pressured speech. 2. Grandiose thoughts. 3. Lack of sleep. 4. Hyperactive behavior.

1 (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.)

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? 1. "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." 2. "Dr. Raye, during her admissions interview Kiley stated that she has had three other suicide attempts in the past." 3. "Kiley, can you tell me more about your depression and your suicide attempt?" 4. "Kiley, I will take you on a tour of the unit and orient you to the rules."

You are caring for Maria, a patient who says she has "ghost sickness." Which is the appropriate nursing response? 1. "i have no idea what 'ghost sickness' is." 2. "how does 'ghost sickness' make you feel?" 3. "'ghost sickness' is not listed in the manual of psychiatric disorders." 4. "let's talk about why you believe in evil spirits."

2 (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.)

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: 1. push Callie gently for more information about the rape because you need to document this in her chart. 2. 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. 3. use silence as a therapeutic tool and wait until Callie is done sobbing to continue discussing the rape. 4. reassure Callie that anything she says to you will remain confidential.

3 (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 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: 1. "I will keep it a secret, but you and I need to discuss ways to deal with this situation appropriately without committing a crime." 2. "Yes, I will keep it confidential. We have laws to protect patients' confidentiality." 3. "Jamie, issues of this kind have to be shared with the treatment team and your parents." 4. "Jamie, I will have to share this with the treatment team, but we will not share it with your parents."

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? 1. "i really believe that my spouse loves me." 2. "my sister will never forgive me for what i did." 3. "i try to find time every day to pray, although it is not easy." 4. "i am happy with my life choices, even if my mother is not."

3 (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.)

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? 1. "I'm sorry, but I cannot take any information from you as it would violate confidentiality laws." 2. "There is no need for that as I will call his primary care provider to obtain the information we need." 3. "Yes, I will be happy to get any information and history that you can provide." 4. "Yes, however, we will have to get a release signed from the patient for you to be able to talk with me."

2 (Least restrictive alternative doctrine is described as using the least drastic means of achieving a specific goal. By doing the actions described you are possibly preventing the more restrictive setting of seclusion and/or restraints. Writ of habeas corpus is a legal term meaning a written order "to free the person." Veracity is one of the five ethical principles or guidelines. Bioethics refers to ethics in a health care setting.)

You are working on an inpatient psychiatric unit and caring for Elizabeth, who is becoming agitated. You speak with Elizabeth one to one in a private setting, find out the reason for the agitation, and then assist Elizabeth with ways to calm down, possibly including prn medication to prevent further escalation of Elizabeth's agitation, which could lead to seclusion and/or restraints. You are making care decisions based on: 1. writ of habeas corpus. 2. least restrictive alternative doctrine. 3. veracity. 4. bioethics.

4, 5 (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.)

You are working on the psychiatric unit and assisting with the care for Mr. Tran, a refugee from Darfur, who came to the United States 1 year ago. Although Mr. Tran understands and speaks some very limited English, he is much more comfortable conversing in his native language. Mike, the nurse working directly with Mr. Tran, says to you, "I am so frustrated trying to communicate with Mr. Tran! He insists on speaking his 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 of the following responses you could make promotes culturally competent care? (select all that apply): 1. "You are right that Mr. Tran needs to speak English, but all patients do have a right to an interpreter, so you need to comply." 2. "I agree that it is frustrating trying to communicate with Mr. Tran. Maybe we could see if his family members can help convince him to try speaking English." 3. "Mr. Tran will have to learn to speak English eventually to live and work successfully in this country. Just try to be patient and encourage him to try speaking English." 4. "What you are saying is actually considered cultural imposition, which is imposing our own culture onto someone from a different culture." 5. "Mr. Tran's ability to speak and understand English is very limited. He needs to have an interpreter to make sure he can make his needs and feelings known."

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? 1. "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." 2. (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." 3. "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." 4. "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."

You have been working closely with a patient for the past month. Today he tells you he is looking forward to meeting his new psychiatrist but frowns and avoids eye contact while reporting this to you. Which of the following responses would most likely be therapeutic? 1. a new psychiatrist is a chance for a fresh start; i'm sure it will go well. 2. you say you look forward to the meeting, but you appear anxious or unhappy. 3. i notice that you frowned and avoided eye contact just now; don't you feel well? 4. i get the impression you don't really want to see your psychiatrist; can you tell me why?

3 (Basic level RNs cannot perform psychotherapy. The other options are all appropriate expectations of a patient's schedule on a psychiatric unit.)

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? 1. "You will participate in unit activities and groups daily." 2. "You will be given a schedule daily of the groups we would like you to attend." 3. "You will attend a psychotherapy group that I lead." 4. "You will see your provider daily in a one-to-one session."

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? 1. "Emma, I'm so sorry. My father died two years ago, so I know how you are feeling." 2. "Emma, you need to focus on yourself right now. You deserve to take time just for you." 3. "Emma, that must have been such a hard situation to deal with." 4. "Emma, I know that you will get over this. It just takes time."

ethical dilemmas

___ ___ are conflicts between two or more courses of action, each with favorable and unfavorable consequences.

day treatment

____ ____ programs are similar to partial hospital programs, but emphasis is social skill development, behavioral regulations, and community living.

(ivan) pavlov

_____ (1849-1936) was a Russian physiologist. He won a Nobel Prize for his outstanding contributions to the physiology of digestion, which he studied through his well-known experiment with dogs. In incidental observation with the dogs, this person noticed that the dogs were able to anticipate when food would be forthcoming and would begin to salivate even before actual tasting of the meat. This physiologist labeled this process psychic secretion. This person hypothesized that the psychic component was a learned association between two events: the presence of the experimental apparatus and the serving of the meat.

(Harry Stack) Sullivan

_____ (1892-1949) was an American-born psychiatrist who initially approached patients from a Freudian framework, but he became frustrated by dealing with what he considered unseen and private mental processes within the individual. He turned his attention to interpersonal processes that could be observed in a social framework. In 1953 he defined personality, anxiety, security operations, and self-system.

(Erik) Erikson

_____ (1902-1994), an American psychoanalyst, was also a follower of Freud; however, this psychoanalyst believed that Freudian theory was restrictive and negative in its approach. This person also stressed than an individual's development is influenced by more than the limited mother-child-father triangle and that culture and society exert significant influence on personality. According to this person, personality was not set in stone at age 5 as Freud suggested, but continued to develop throughout the lifespan.

(hildeguard) Peplau

_____ (1909-1999), influenced by the work of Sullivan and learning theory, developed the first systematic theoretical framework for psychiatric nursing in her groundbreaking book "Interpersonal Relationships in Nursing" (1952). She not only established the foundation for the professional practice of psychiatric nursing but also continued to enrich psychiatric nursing theory and work for the advancement of nursing practice throughout her career.

mental health

_____ _____ is defined as the ability to recognize their own potential, cope with normal stress, work productively, and make contributions to the community.

releases AMA

_____ _____ is used in some cases when there is a disagreement between the mental health care providers and the patient as to whether continued hospitalization is necessary. In cases where treatment seems beneficial but there is no compelling reason (e.g. danger to self or others) to seek an involuntary continuance of stay, patients may be released in this method.

religion

_____ is an external system that includes beliefs, patterns of worship, and symbols. An individual connects personal, spiritual beliefs with a larger organized group or institution. Belonging to a religious community can provide support during difficult times. For many, prayer is a source of hope, comfort, and support in healing.

resilience

_____ is closely associated with the process of adapting and helps people facing tragedies, loss, trauma, and severe stress. It is the ability and capacity for people to secure the resources they need to support their well-being, such as children of poverty and abuse seeking out trusted adults who provide them with the psychological and physical resources that allow them to excel. The social support actually brings about chemical changes in the body through the release of oxytocin, which mutes the destructive stress-related chemicals.

primary, secondary, tertiary

_____ prevention occurs before any problem is manifested and seeks to reduce the incidence, or rate of new cases. _____ prevention is also aimed at reducing the prevalence, or number of new and old cases at any point in time, of psychiatric disorders. _____ prevention is the treatment of disease with a focus on preventing the progression to a severe course, disability, or even death.

unconditional

_____ release is the termination of patient-institution relationship. This release may be court-ordered or administratively ordered by the institution's officials. Generally, the administrative officer of an institution has the discretion to discharge patients.

conditional

_____ release usually required outpatient treatment for a specified period to determine the patient's adherence with medication protocols, ability to meet basic needs, and ability to reintegrate into the community. Generally, a voluntary admitted patient who is conditionally released can only be involuntarily admitted through the usual methods; however, an involuntarily admitted patient who is conditionally released may be re-institutionalized, although the commitment is still in effect without recommencement of formal admission procedures.

milieu

_____ therapy (coined in 1948) describes the use of the total environment to treat disturbed children. Staff members were trained to provide 24 hours support and understanding for each child on an individual basis.

(John B.) Watson

______ (1878-1958) was an American psychologist who rejected the unconscious motivation of psychoanalysis as being too subjective. He developed the school of thought referred to as behaviorism, which he believed was more objective or measurable. This person contended that personality traits and responses - adaptive or maladaptive - were socially learned through classical conditioning. In a famous (but terrible) experiment, He stood behind Little Albert, a 9 month old, who liked animals, and made a loud noise with a hammer every time the infant reached for a white rat. After this experiment, Little Albert became terrified at the sigh of white fur or hair, even in the absence of loud noise. He concluded that controlling the environment could mold behavior and that anyone could be trained to be anything, from a beggar man to a merchant.

(B.F.) Skinner

______ (1904-1990) represented the second wave of behavioral theorists. This person researched operant conditioning and reinforcement, both positive and negative.

(Abraham) Maslow

______ (1908-1970) is considered the father of humanistic psychology and introduced the concept of a "self-actualized personality" associated with high productivity and enjoyment of life. He criticized psychology for focusing too intently on humanity's frailties and not enough on its strengths. Maslow contended that the focus of psychology must go beyond experiences of hate, pain, misery, guilt, and conflict to include love, compassion, happiness, exhilaration, and well-being.

long-term involuntary

______ ______ admission has as its primary purpose extended care and treatment of the mentally ill. Those who undergo this model of hospitalization are admitted through medical certification, judicial review, or administrative action. Some states don't require a judicial hearing before admission but often provide the patient with an opportunity for a judicial review after administration procedures. This type of hospitalization usually lasts 60-180 days, but it may also be for an indeterminate period.

involuntary

______ admission is admission to a facility without the patient's consent. Generally, this model of admission is necessary when a person is in need of psychiatric treatment, presents a danger to self or others, or is unable to meet his or her own basic needs. This type of admission requires that the patient retain freedom from unreasonable body restraints, the right to informed consent, and the right to refuse medications, including psychotropic drugs or antipsychotic medications. Usually two physicians certifies that a person's mental health status justifies detention and treatment. Additionally, someone who is familiar with the patient and believes that he or she needs treatment usually makes a formal application for admission. Patients can be kept up to 60 days.

informal

______ admission is one type of voluntary admission that is similar to any general hospital admission. The patient seeks this type of admission. Under this model, the normal doctor-patient relationship exists, and the patient is free to stay or leave , even AMA.

temporary

______ admission is used (1) for people who are so confused or demented they cannot make decisions on their own or (2) for people who are so ill they need emergency admission, and then a psychiatrist employed by the hospital must confirm the need for hospitalization. The primary purpose of this type of hospitalization is observation, diagnosis, and treatment of those who have mental illness or pose a danger to themselves or others. The length of time and procedures vary markedly from state to state; generally, a patient can be held no more than 15 days under this admission model.

voluntary

______ admission occurs when a patient applies in writing for admission to the facility. If the person is under 18, the parent, legal guardian, custodian, or next of kin may have authority to apply on the person's behalf. This type of admitted persons have the right to request and obtain release; however, patients may be re-evaluated and a decisions may be made on the part of the care provider that an involuntary admission be initiated according to criteria established by state law.

operant

______ conditioning includes voluntary behaviors that are learned through consequences and behavioral responses are elicited through reinforcements.

NANDA-I

______ describes a nursing diagnosis as a clinical judgement about individual, family, or community responses to actual or potential health problems and life processes. It provides the framework for identifying appropriate nursing interventions.

transference

______ is a concept from classic psychoanalysis that refers to feelings that the patient has towards health care workers that were originally toward significant others in his or her life. When this occurs, these feelings become available for exploration with the patient. Such exploration helps the patient to better understand certain feelings and behaviors.

countertransference

______ is a concept from classic psychoanalysis that refers to unconscious feelings that the health care worker has toward the patient. For instance, if a patient reminds you of someone you do not like, you may unconsciously react as if the patient were that individual. It underscores the importance of maintaining self-awareness and seeking supervisory guidance as therapeutic relationships progress.

spirituality

______ is more of an internal phenomenon and is often understood as addressing universal human questions and needs. It can be expressed as having 3 dimensions: cognitive (beliefs, values, ideals, purpose, truth, wisdom); experiential (love, compassion, connection, forgiveness, altruism); and behavioral (daily behavior, moral obligations, life choices, and medical choices). It is the part of us that seeks to understand life and may or may not be connected with the community or religious rituals. The believer's faith is thought to be more personal and less dogmatic, more inclusive, considering the belief that there are many spiritual paths and no one "real path."

involuntary

______ outpatient commitment arose in the 1990's when states began to pass legislation that permitted outpatient commitment as an alternative to forced inpatient treatment. More than 40 states now have this mandate This model can be a preventive measuring, allowing a court order before the onset of a psychiatric crises that would result in an inpatient admission. The order for this model is usually tied to receipt of goods and services provided by social welfare agencies, including disability benefits and housing. To access these goods and services, the patient is mandated to participate in treatment and may face inpatient admission if he or she fails to participate in treatment. MH America ( 2012), an advocacy group, opposes the use of this type of involuntary treatment based on the belief that it is coercive and may be counterproductive by reducing personal responsibility and lowering self-esteem.

interpersonal

______ psychotherapy is an effective short-term therapy derived from the school of psychiatry that originated with Adolph Meyer and Harry Stack Sullivan. The assumption is that psychiatric disorders are influenced by interpersonal interactions and social context. The goal of this theory is to reduce or eliminate psychiatric symptoms (particularly depression) by improving interpersonal functioning and satisfaction with social relationships.

psychodynamic

______ therapy follows the psychoanalytical model by using many of the tools of psychoanalysis, such as free association, dream analysis, transference, and countertransference, however, the therapist has increased involvement and interacts with the patient more freely than in traditional psychoanalysis. The therapy is oriented more to the here and now and makes less of an attempt to reconstruct the developmental origins of conflict. This therapy tends to last longer than other therapeutic modalities and may extend for more than 20 sessions, which insurance companies often reject.

behavior

______ therapy is based on the assumption that changes in maladaptive behavior can occur without insight into the underlying cause. This approach works best when it is directed at a specific problem and the goals are well defined. This type of therapy is effective in treating people with phobias, alcoholism, schizophrenia, and many other conditions. Four types include: modeling, operant conditioning, systematic desensitization, and aversion therapy.

REBT (rational-emotive behavioral therapy)

______ was developed by Albert Ellis (1913-2007) in 1955. The aim of this therapy is to eradicate core irrational beliefs by helping people recognize thoughts that are not accurate, sensible, or useful. These thoughts tend to take the form of should's ("I should always be polite), ought's (I ought to consistently win my tennis games), and musts ("I must be thin). Ellis describes negative thinking as a simple A-B-C process. A stands for activating event, B stands for beliefs about the event, and C stands for emotional consequences as a result of the event.

epidemiology

______, as it applies to psychiatric mental health, is the quantitative study of the distribution of mental disorders in human populations. Once distribution of mental disorders has been determined qualitatively, experts can identify high-risk groups and high-risk factors associated with illness onset, duration, and recurrence.

prevalence

_______ describes the total number of cases, new and existing, in a given population during a specific time period, regardless of when they became ill. Ex: The number of adolescents who screen positive for major depression in NYC school between 2000-2010.

resilience

_______ is the ability and capacity to secure resources needed to support well-being. It is characterized by optimism, a sense of mastery, and competence. It is essential to recovery. Early mastery of stress enhances pre-frontal cortex's resiliency to cope.

interpersonal

_______ psychotherapy has proved successful in treatment of depression. Treatment is predicated on the notion that disturbances in important interpersonal relationships (or a deficit in one's capacity to form those relationships) can play a role in initiating or maintaining clinical depression. In this therapy, the therapist identifies the nature of the problem to be resolved then selects strategies consistent with that problem area.

incidence

_______ refers to the numbers of new cases of mental disorders in a healthy population within a given period of time. Ex: The number of Atlanta adolescence who were newly diagnosed with major depression between 2000 and 2001. This is usually annual.

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