Psych Exam 1 NCLEX

111. When considering a group home setting, what is the common need demonstrated by all the residents? a. Assistance with independent living tasks b. Financial assistance c. Suicidal prevention assistance d. Assistance with the management of aggression and anger

A - A group home is a moderately sized, approximately 6- to 12-bed program located in a neighborhood setting that is staffed with nonclinical paraprofessionals who provide specialized services offered within the context of a 24/7 home-like milieu. It is a structured service program that creates a physically, emotionally, and psychologically safe environment for children, adolescents, or adults with moderate psychological needs who are either too young or lack the skills necessary to function in an independent living situation. While the other needs may exist, they are not common to all residents.

94. When discussing pharmacokinetics, a patient experiencing gastrointestinal problems may have a problem with which process? a. Absorption b. Distribution c. Metabolism d. Excretion

A - Absorption refers to getting the medication into the bloodstream. Drugs taken orally must get out of the gastrointestinal tract and into the bloodstream to have an effect. Distribution is associated with moving the medication from the bloodstream to the tissues and organs. Metabolism is the breakdown of the medication into a usable form. Excretion is associated with eliminating the medication from the body.

37. Which ethnic group has a worldview where knowledge is acquired through proof that something exists? a. European-American b. Arabic c. Asian d. Native American

A - According to the European-American worldview, knowledge is acquired according to proof of the existence of anything—that is, the ability of an individual to see, hear, touch, taste, or smell it. The Arabic worldview holds that knowledge bases are developed through the use of the affective or feeling senses. According to the Asian worldview, knowledge bases are developed in striving for transcendence of the mind and body. Native Americans believe that knowledge bases are developed on the basis of a person's understanding of an individual's relationship with the Greater or Supreme Being.

77. Which statement made by a group member who experienced severe anxiety demonstrates altruism? a. "I'm glad my experience has helped others here who don't have a job." b. "It's so important to remain hopeful." c. "I am thankful not to feel so alone anymore." d. "You all have given me some great help in effectively managing anxiety."

A - Altruism occurs when patients experience themselves as helpful or useful to others. Expressing the importance of hopefulness is related to the instillation of hope. Universality is demonstrated when patients experience relief in knowing that they are not alone and unique, but that others experience similar problems, feelings, and concerns. Providing tips is associated with the concept of imparting of information.

50. Which question should the nurse ask when utilizing the interpersonal approach when working with a patient? a. "How would you describe your relationship with your partner?" b. "Have you ever been told that you are often angry?" c. "Have your considered appointed a power of attorney to manage your business affairs?" d. "How much money do you spend fast food?"

A - An assessment of significant relational issues according to Sullivan would be associated with the interpersonal approach. Assessment of the patient's appraisal of the stress/coping response (Lazarus) would be associated with assessing anger. Assessment of Erikson Developmental Theory (trust-versus-mistrust mastery) is associated with trust. A statement by the nurse about the patient's maladaptive response in spending money on fast food, pointing out irrational thoughts leading to maladaptive behaviors, would be associated with the cognitive approach.

2. A patient with which medical history would best meet the criteria for enrollment in an apartment living program? a. Schizophrenia and diabetes b. Depression and exercise-induced asthma c. Borderline personality disorder and hypertension d. Bipolar disorder and gastroesophageal reflex disorder GERD)

A - Apartment living programs provide varying degrees of supervision and programming for the severely mentally ill. Staff might be on site on a daily basis, offering group sessions and activities, or they might visit periodically to provide medication assistance and attendance at various appointments that can include those for medical conditions. The diagnosis of schizophrenia is one of severe mental illness, while diabetes requires daily management; this patient meets the criteria for the apartment living program model. The individuals with any of the other comorbid diagnoses would probably be followed up in a clinic setting and benefit from opportunities in the community (e.g., psychoeducation groups, support groups, and social groups) with medical being available as required.

33. The nurse is assessing a patient of a racially diverse group regarding their use of alternative therapies. Which question will the nurse ask? a. "What do you think will make you feel better?" b. "Do you believe in folk healers?" c. "How long have you been ill?" d. "Can you tell me about your spiritual beliefs?"

A - Asking about past medical practices begins an assessment and both determines the use of complementary and alternative therapies while providing an opportunity for the patient to speak about other healing, wellness, or health options. Directly asking a closed-ended question about a belief may challenge the patient. While asking when the illness began is an act-based question, it is not related to alternative therapies. A general question concerning spiritual belief is too broad and may not assess for use of alternative therapies.

61. When a case manager uses a telephone to communicate with a high-risk patient, what aspect of illness is most positively impacted? a. Relapse potential b. Social isolation c. Medication compliance d. Suicide prevention

A - Case management for high-risk patients can utilize phone contact to facilitate discharge planning and increase adherence to follow-up appointments and treatment, thus reducing recidivism (relapse). While telephone conversations can help minimize social isolation, that is not the focus of the case manager's interventions. Medication compliance and suicide prevention would require the patient taking the initiative to call the case manager.

109. What is the common mental health diagnosis seen in all patients admitted to a co-occurring-disorders unit of a psychiatric hospital? a. Substance abuse b. Depression c. Obsessive-compulsive disorder d. Anxiety

A - Co-occurring-disorders inpatient units focus on the treatment of substance abuse and mental illness in a psychiatric hospital setting. These units provide detoxification services, as well as psychotherapy and group activities. Treatment plans address the patients' substance abuse or dependence, psychiatric illness, and the relationship between the co-occurring disorders. All patients have another existing mental health disorder that may include the other options.

62. The nurse is caring for a severely depressed patient who, while driving, accidentally killed a child who darted out into traffic. Which nursing intervention is focused upon the patient's content communication themes? a. Assessing for suicidal ideations b. Encouraging a discussion regarding the guilt the patient feels c. Exploring the role family can play in the patient's recovery d. Identifying ways the staff can assist the patient in finding inner peace

A - Content themes go beyond the words that a patient is saying and examine underlying messages about patients' perceptions of themselves and their problems including the risk for suicide. Mood themes relate to affect and the feelings conveyed while patients discuss their issues and concerns. Feelings often reflect shame, guilt, anger, sadness, and fear, which might or might not match the content theme. Assessing for interaction themes involves examining the ways in which patients relate to family, friends, other patients, and staff.

66. What statement suggests that the nurse is experiencing the situation referred to countertransference? a. "He reminds me so much of my sweet uncle." b. "That patient asked me out to dinner." c. "I think the team needs to discuss how best to manage the patient's manipulative behaviors." d. "I believe it's okay to cry."

A - Countertransference usually consists of feelings related to persons other than the patient but transferred to the patient. This range of both positive and negative feelings may interfere with the ability to be therapeutic. Reporting a patient's attempt at arranging a social interaction or the need to manage a patient's maladaptive behavior are appropriate occurrences to report to the team but do not demonstrate countertransference. Crying is not associated with countertransference.

14. A nurse is asked by a student what aspect of nursing was directly influenced by Hildegarde Peplau. The response is based upon what focus? a. Practice of psychiatric nursing b. Psychiatric textbooks c. First psychiatric nurse d. Concept of psychiatric asylum

A - Hildegarde Peplau (1952, 1959) developed a model for psychiatric nursing practice. Her book, Interpersonal Relations in Nursing (1952), influences practice to this day. In 1920, Harriet Bailey wrote the first psychiatric nursing textbook. Linda Richards, the first American psychiatric nurse, was a graduate of the New England Hospital for Women. Richards spent much of her professional career developing nursing care in psychiatric hospitals and also directed a school of psychiatric nursing in 1880 at the McLean Psychiatric Asylum in Waverly, Massachusetts. Dorothea Dix (1802 to 1887), one of the first major reformers in the United States, was instrumental in developing the concept of the asylum.

60. A patient in an outpatient program asks the nurse, "to if he can keep this a secret." What statement best represents the nurse's most appropriate reply? a. "I am not able to keep a secret, because I share our work together with the health care team here." b. "Please tell me first, and then I will decide if I can keep it a secret." c. "I will only tell your secret if it involves harm to you or another." d. "Yes, I can keep a secret."

A - In a therapeutic relationship, the nurse is not a friend but is an advocate, one who facilitates care within a team approach. The patient must know the nurse's position on secret keeping before sharing information. While safety is a major nursing concern, there are other issues that require disclosure to the team. Secret keeping is a potential professional-boundary violation.

44. Which client statement should the nurse directly associated with the work of James Loder and spiritual dynamics? a. "I can't trust you are anyone else to be there for me."Loder b. "Belonging to a loving group of people is vital to my ability to cope." c. "I survived the flood so I need to pay back for my good fortune." d. "I've had to learn to accept myself and who I am."

A - James E. Loder (1989) postulated that early developmental experiences set the stage for later spiritual dynamics within the individual. By the age of 9 months, the child will understand when the mother is not present and will experience anxiety at her absence. The child's burgeoning capacity to trust is strengthened by the presence (face) of the nurturer. Loder notes that the child experiences no shame when gazing at this face, so this model can be useful in helping deal with issues of abandonment and shame. Levin and Ion identified four factors of resilience essential for coping, which Levin calls the four B's that are associated with the remaining options.

96. What is the primary expected outcome for patient education that focuses on medication understanding? a. Improved medication compliance by the patient. b. Appropriate attention to nursing responsibilities. c. Effective patient-focused advocacy. d. Reduction of undesired side effects.

A - Many rehospitalizations are related to patients' nonadherence to medication schedules. As knowledge deficits are removed, better compliance can be anticipated. While it is true that nursing responsibilities and advocacy are foci of nursing interventions, attention to either of these is not the primary expected outcome for patient education. Medication education can assist in the early detection and proper management of medication side effects but has no relevance to the reduction of such events.

34. An Asian-American patient is prescribed a psychotropic medication. He expresses a concern by stating, "I heard that my body may react to certain medications in a different way because of my heritage." The nurse will respond to his concern by stating: a. "There are enzymes that can affect the metabolism of some medications for individuals in your cultural group." b. "There are differences but research doesn't support any significant effects." c. "Please don't be too concerned about this. I'll ask your primary provider to speak to you about it." d. "How did you find out about this issue?"

A - Since this is a true statement, the best response is to provide accurate psychoeducation information for the individual that includes the possible effects and the measures taken to avoid them. This is a question the nurse should be prepared to answer, and it should not be passed along to the doctor; doing so appears to minimize the individual's concerns. Asking how the patient became aware of this information minimizes his concerns and serves only to distract him from an answer.

103. With the implementation of the concepts of therapeutic community, what is the rationale upon which decision making is based? a. Daily group meetings serve as the forum for all patients to be involved in the decision-making process. b. Any decision that affects the therapeutic nature of the community is made by the health care team. c. Patients whose cognitive function is affected by their mental health diagnosis are excluded from the unit's decision-making process. d. The privilege to be included in decision making is earned by the individual patient through compliance with his or her treatment plan.

A - The Therapeutic Community by Maxwell Jones proposed that patient involvement in decision making is achieved through daily group meetings. Input into decisions affecting patients and their care is considered a right and cannot be denied them. Cognitive dysfunction may limit participation but cannot be a barrier to the decision-making process.

82. Which statement by the nurse is an example of "gate keeping" as a technique to manage a dominant member of a group? a. "I'm pleased with your contribution to the discussion; now it's time to hear from another member." b. "I believe you have been given ample opportunity to express your feelings; now it is someone else's turn." c. "You have given us a very detailed description of your problems; if you need more time, we can provide it at the next session." d. "It appears that you have a strong need to control the discussion; can you talk to us about why that is so important to you?"

A - The dominant patient monopolizes the entire group session to the extent that other patients might believe that they do not have the opportunity to participate. The nurse uses gate-keeping techniques like those in the correct answer that can forestall monopolization of the group by a single patient without putting her down, while providing others with the opportunity to express themselves. Terminating the patient's opportunity to speak without making a positive comment first would probably be viewed as rude or offensive. It is not effective to provide the monopolizing patient the opportunity to again dominate the conversation. Switching the focus to the patient's need to monopolize the session will serve only to allow the patient to continue that behavior.

5. Which patient requires the highest priority for a hospital-based admission? a. A young adult who verbalizes a plan to hurt their spouse b. An elderly adult with a history of major depression c. A teenager demonstrating poor impulse control d. An older adult diagnosed with generalized anxiety

A - The highest priority for admission to hospital-based care is safety for self and others. When a patient is deemed a danger to himself (suicidal) or to others (homicidal), 24-hour supervision in a secure environment is required. While depression, poor impulse control, and anxiety may escalate to the point where the patient is a danger to self or others, these disorders do not have priority over reasonable homicidal threats that have been verbalized.

98. A client with which medical diagnosis has the greatest risk for poor metabolism of the drug clozapine? a. Liver disease b. Renal cancer c. Atherosclerosis d. Crohn disease

A - The liver is the site of most drug metabolism and so a related diagnosis is a risk related to the metabolism of any drug. The renal system is associated with the excretion of drugs. The gastrointestinal system refers to absorption, while the circulatory system is associated with distribution.

89. Which statement by the nurse is likely to have the greatest positive impact on assuring co-operation by the members of a dysfunctional family? a. "I am so pleased to see all of you here for the therapy session." b. "You all have the right to be a member of a functional, loving family." c. "I am here to help you all resolve your problems in any way I possibly can." d. "You should respectfully discuss how to resolve your problems with each other."

A - The nurse can offer positive reinforcement about the patient's willingness to engage in the treatment process. Even if the patient is only minimally co-operative with treatment, positive reinforcement can serve to improve the patient's co-operation and boost his or her self-esteem. The remaining statements, while true, are not as likely to assure co-operation between family members and with treatment as a whole as will positive reinforcement for the efforts they are showing.

73. The nurse will probably spend more time on the orientation phase of the nurse-patient relations with which patient? a. The highly distrustful teenager who ran away from an abusive home situation b. The young mother who wants to return home to her young children c. The older adult who is admitted for 3 days for adjustments to his medication regime d. The middle-aged adult who voluntarily admitted himself for drug detox treatment

A - The nurse concentrates on nursing approaches in a particular phase, depending on the status and needs of individual patients. For example, approaches used in the orientation phase have priority when the patient is highly suspicious, because a need exists to develop trust with the patient. The distrustful patient will require additional interventions associated with the orientation phase. For the patient with good insight and motivation such as the young mother and the middle-aged adult, approaches in the working phase are most important because they concentrate on problem solving and change. If the patient is to be admitted for only 3 days, then approaches used in the termination phase are critical because of the need for formalizing plans for follow-up care and referrals to other services along the continuum of care.

23. Which statement made by the nurse demonstrates accurate knowledge concerning the diagnosis of schizophrenia? a. "It is believed that schizophrenia is related to a surplus of a substance in the brain called dopamine. Medications, therapies, and treatments can help manage the disorder." b. "There is little known about what may cause schizophrenia. What is known is that the brain develops in an abnormal manner." c. "Schizophrenia is not believed to be genetic in nature but rather trauma-related." d. "There has been little research in the cause and treatment of schizophrenia."

A - The option that is most responsive in communicating, in layperson terms, current understanding regarding the causation of schizophrenia identifies the role of dopamine. Although a definite cause is still unconfirmed, research has produced several viable theories regarding the cause of schizophrenia. One of those theories includes a possible genetic link not trauma.

15. When asked about the benefits of psychiatric drug therapy, which outcomes should the nurse discuss? (Select all that apply.) a. Hospital stays are now shorter. b. The cost of medications have decreased. c. Hospital environments are now more therapeutic. d. Medications have become a primary treatment modality. e. Acute-care hospital stays are less expensive as a result

A and C - Major events associated with the period of psychiatric drugs include the shortening of the length of hospital stays and the improvement of hospital environments. The introduction of mental health-oriented medications has not significantly affected costs of medications or hospital stays. While medications are a vital part of mental health treatment, they are not necessarily considered primary.

7. Which interventions are directly associated with the components of effective psychotherapeutic management of the mentally ill client? (Select all that apply.) Establishing a respectful nurse-patient relationship Providing appropriate education for prescribed medications Enforcing unit rules to help assure milieu safety Including the patient's family in discharge planning when possible Addressing patient needs using the multidisciplinary team model

A, B and C - The components of psychotherapeutic management include interventions directed towards a therapeutic nurse-patient relationship (Me), psychopharmacology (Meds), and Milieu or "environment" management, all of which are supported by a basic understanding of psychopathology. While appropriate the remaining options are not directly associated with essential components of this management model.

8. Which nursing interventions are associated with the foci of psychotherapeutic management? (Select all that apply.) Implementing 15-minute checks for a depressed patient who has acknowledged having suicidal ideation a. Discussing the need for medication compliance with a patient diagnosed with schizophrenia b. Recognizing the need for confidentiality when documenting patient-related information c. Using simple, concrete language when talking to a cognitively impaired patient d. Appropriately supporting a patient's autonomy when hospitalization is required

A, B and D - Psychiatric treatment can be divided into five basic categories: (1) use of words, (2) use of drugs, (3) use of environment, (4) somatic therapies, and (5) behavioral conditioning. Psychotherapeutic management emphasizes the first three of these categories: (1) words from which nurses develop the nurse-patient relationship, (2) drugs, specifically psychotropic drugs, and (3) environment (as noted, the French word for environment, milieu, is often used). Implementing 15-minute safety checks is associated with providing a safe milieu for the suicidal patient. Discussing medication compliance relates to the medication needs of the schizophrenic patient, while using simple, concrete language is especially important when dealing with the cognitively impaired patient. Confidentiality and the preservation of autonomy are generalized interventions not associated with psychotherapeutic management.

29. When it is documented that a patient has basal ganglia dysfunction, the nurse will expect which assessment findings? (Select all that apply.) a. Sudden, unexpected flailing of an arm b. Resting tremors in the hands c. Involuntary, rapid eye movement d. Decreased, unilateral tendon reflexes e. General lack of coordination

A, B, C - Basal ganglia dysfunction can result in hemiballismus (a sudden, wild flailing of one arm), nystagmus (involuntary rapid eye movements), and resting tremor as seen in parkinsonism. A decrease in tendon reflexes unilaterally and a general lack of coordination described as ataxia are related to cerebellar dysfunctions.

21. What elements must be present for a nurse to be found guilty of negligence and for damages to be awarded? (Select all that apply.) a. The nurse had a duty to care for the patient. b. The nurse had an obligation to provide reasonable care. c. The nurse failed to perform an expected duty. d. The nurse was aware that the standard of care was not met. e. The nurse's actions resulted in injury to the patient.

A, B, C, E - The four elements that must be present for a plaintiff to recover damages caused by negligence are the nurse's duty to care, the obligation of reasonable care (i.e., standard of care), breach of duty, and injury proximately caused by a breach of duty. It is not necessary that the nurse be aware that the standard of care was not being met.

38. Which assessment questions are significant when considering cultural diversity? (Select all that apply.) a. "How old were you be on your last birthday?" b. "Have you ever been diagnosed with a mental illness?" c. "Do you identify with a particular religion?" d. "How many biological siblings do you have?" e. "Are you currently diagnosed with any chronic physical disorders?"

A, B, C, E - The term cultural diversity might encompass areas such as age, gender, socioeconomic status, religion, race, ethnicity, mental illness, and physically challenging conditions. Neither the size nor the composition of one's family appears to have a significant impact on cultural diversity.

22. Which actions will best assure that the nurse is delegating to a novice, unlicensed assistive personnel (UAP) both legally and with attention to the patient's care needs? (Select all that apply.) a. Consulting the facility's policy manual to determine the UAP's scope of practice b. Reviewing the state's nursing practice act to determine if the task is delegatable c. Assigning the novice UAP to shadow an experienced UAP who is proficient at the task d. Initially supervising the UAP performing the delegated task e. Assuring the patient that the novice UAP is qualified to perform the task

A, B, D - When delegating, the nurse should know and follow the local hospital procedures so as to stay within his or her scope and authority, ensure that UAPs assigned have been fully trained and are qualified to carry out the tasks they are expected to perform, and know the limitations and responsibilities of nursing practice of his or her state. Such responsibility may not be delegated to another UAP. Notifying the patient is not considered a part of the delegating process

20. What action will the psychiatric mental health nurse who demonstrates an understanding of patient rights engage in? (Select all that apply.) a. Discussing all patient related issues only with multidisciplinary team members when in areas of privacy. b. Taking action to honor the patient's medical and psychiatric advanced directives. c. Remaining "logged on" to the patient's electronic medical record during the shift to facilitate documentation. d. Introducing oneself before initiating any patient-focused discussions. e. Requesting permission to interact and work with the patient.

A, B, E, D - Considering privacy, honoring patient requests, and demonstrating courtesy and respect are all examples of patient advocacy and appropriate professional conduct. Confidentiality requires that a patient's medical record be opened only when actual documenting is occurring.

39. Which questions contribute to the formulation of health care actions and beliefs on the part of both nurses and patients? (Select all that apply.) a. "Can you define for me what it means to be healthy?" b. "How much formal education have you had?" c. "What do you believe caused your current illness?" d. "Can you describe your cultural worldview?" e. "Have you been diagnosed with any chronic illness,"

A, C, D - Nurses' and patients' health care actions and beliefs are generally formulated by three factors: (1) their definition of health; (2) their perception of the way in which illness occurs; and (3) their cultural worldview. Education and experience with illness are not recognized as factors that contribute to the formulation of one's beliefs and actions regarding health care.

30. Which statements concerning episodic memory should be shared with the family of a client newly diagnosed with dementia? (Select all that apply.) a. Occurs in the parietal lobes of the brain. b. Involves dysfunction of the hippocampus. c. Relates to information acquired through the senses. d. Doesn't require contextual cues to be triggered e. Involves links to cues from the environment

A, C, E - Episodic or contextual memory is mediated by the hippocampus from information acquired through one of the senses. Memory traces linked to cues from the environment are combined with other memory traces temporally related to an event, to form a more complete memory of that event. Semantic memory, occurring in the parietal lobes, is involved with the retrieval of memories which do not have contextual cues.

47. In assessing the spiritual needs of the patient experiencing psychosis, what factors should the nurse consider? (Select all that apply.) a. Speaking slowly b. Focusing on spiritually during the initial assessment c. Speaking quietly d. Wording the questions in a concrete manner e. Wording the question abstractly

A, D - Slow responses afford processing and facilitate understanding, as does the use of concrete words and examples. The initial assessment may not be the appropriate time to address the issue of the patient's spiritual needs. Speaking quietly may not meet the patient's needs; abstract language with the psychotic patient is not supported in evidence-based care. It is not appropriate to avoid the subject, since it does not speak to the patient's spiritual needs.

10. A community leader comments: "These homeless people are really a problem. Many of them seem mentally ill." How should the nurse respond to best address the needs of the homeless? a. "You must consider funding mental health assessments and services for these people." b. "The increase in available homeless shelters is needed to help meet their basic needs." c. "Law enforcement authorities require effective intervention training when dealing with the mental ill homeless population." d. "If the community could provide employment opportunities for the homeless, it would help them become independent."

A- Effective management of the homeless population begins the assessment process and focuses on money and services needed in the community. While basic needs are important, evidence suggests that many homeless persons have unmet mental health needs. Law enforcement authorities intervene only on a crisis basis, as a last resort for the individual. Vocational training and job skills might be of benefit to this population but may not be the highest priority or responsive to current needs.

72. Which statement made by the nurse best demonstrates the technique of self-disclosure when discussing a depressed patient? a. "Depression runs in my family. Does any family member of yours have depression too?" b. "Feeling lonely can make me depressed. What kinds of things make you feel depressed?" c. "Medication helped me when I was depressed. Have you ever been prescribed an antidepressant medication?" d. "I was so depressed once, I actually thought about suicide. Have you ever thought about hurting yourself?"

B - A self-disclosure should be planned, patient-centered, and goal-directed. The disclosure guides the conversation toward the exploration of patient problems, issues, and needs. Such disclosures help the patient clarify issues and feel less vulnerable and more normal. Therapeutic self-disclosure facilitates comfort, honesty, openness, and risk taking but never burdens patients with the nurse's problems. Directing the conversation to possible triggers is the best example of self-disclosure, since it opens the topic and divulges very general personal information. Sharing a family history of depression, the fact that the nurse was once prescribed antidepressant medication, and that suicide was once considered constitute personal information that is inappropriate to share and burdensome to the patient.

1. Which statement demonstrates the nurse processes an understanding of the role of a psychiatric nurse regarding discharge planning? a. "I will work on the patient's discharge planning as soon as he is stable." b. "I will address your discharge concerns with your multidisciplinary team today" c. "Discharge planning is not as high a priority for those with chronic mental illnesses." d. "Discharge planning is discussed with the family once the decisions have been made."

B - An understanding of collaboration and a team approach demonstrates the RN's understanding of the nurse's role in discharge planning. Discharge planning begins at the point of admission, regardless of the patient's condition. Effective discharge planning may prevent recidivism, relapse, and rehospitalization. All significant others need input and participation in the process of planning discharge.

32. When a nurse assesses a patient's nutritional history, which question demonstrates cultural sensitivity? a. "How much do you think you should weigh?" b. "What foods do you eat when you are ill?" c. "Are you the cook in your home?" d. "Are you hungry?"

B - Assessment of intake and type or preference of food when ill respects and honors the patient's cultural diversity. Weight is not an objective indicator of nutritional status and is not related to culture. The questions regarding who cooks and if the patient is hungry are both closed-ended questions and neither speaks to cultural assessments.

97. When considering pharmacokinetics, what is the primary safety concern for a client prescribed lithium? a. Impaired cognitive function b. Increased risk for self-harm medication c. Increased risk of abuse or dependency d. A decrease of libido

B - Because some drugs, such as tricyclic antidepressants and lithium, have a narrow therapeutic index the difference between under-dosage and toxicity is very slight. Because of this characteristic thoughts of self-harm must be discussed with the patient. These classifications of medication are not known for affecting cognitive function, having a high potential for abuse or dependency, or reducing libido.

93. The effects of highly lipid-soluble substances such as nicotine, diazepam, ethanol, caffeine, and heroin are best conceptualized by understanding the function of which process? a. Distribution b. blood-brain barrier c. Hepatic system d. Renal system

B - Being highly lipophilic, these substances rapidly pass the blood-brain barrier and thus exert their respective physiologic effects. While distribution is involved, it is not primary in the effects identified in the stem. Neither hepatic nor renal systems are associated with the absorption of lipid-soluble substances.

13. What response should the nurse provide when asked to compare today's mentally ill patients with those observed in the 1960s and 1970s? a. In the 1960s and 1970s, the primary mental health diagnosis was depression. b. Today's patients are more aggressive and often armed when seen on initial assessment. c. Today there are more people hospitalized with mental illness than in the 1960s and 1970s. d. Jails and prisons house fewer mentally ill persons today than during the 1960s and 1970s.

B - Compared with the patients of the 1960s and 1970s, today's patients are more aggressive and many are armed when first seen. Depression was not necessarily the primary mental health diagnosis during the 1960s and 1970s. The hospital population peaked in 1955 and has declined steadily to this day. Today there are 300% more patients with severe mental illness in jails and prisons than there are in hospitals in the United States; these numbers have increased steadily over the last several decades.

52. What statement would the nurse identified as a major nursing goal associated with interpersonal relationship therapy related to patient care? a. Patient will focus attention on past experiences that distort relationships. b. Patient will challenge any existing negative self-image. c. Patient will develop effective problem-solving skills. d. Patient will convert anxiety to constructive action.

B - Considering interpersonal relationship therapy, a major goal of nursing constitutes helping patients reduce their anxiety and convert it to constructive action. It is the therapist's role to focus on the patient's interpersonal issues and distortions created by past experiences. In challenging a negative self-image, the therapist presents an appraisal of the patient as a worthwhile, respectable individual with rights, dignity, and valuable abilities. Nurses help patients change irrational beliefs and reduce stress and anxiety through effective problem solving when engaging in cognitive therapy.

24. A patient newly diagnosed with depression tearfully expresses a need to know more about the disorder. The nurse's response to the patient's needs is based on which statement? a. "The details regarding depression can be difficult to comprehend, especially when one is experiencing the disorder." b. "It is known that depression is a result of the imbalance of the neurotransmitters norepinephrine and serotonin." c. "The patient's ability to comprehend the details regarding depression is limited until the tearfulness is managed." d. "Depression is different for each individual who experiences it, and so discussing it with patients is difficult."

B - Discussing the fact that the disorder is a result of an imbalance of neurotransmitters constitutes responsive communication that uses layperson terms. It is not responsible communication to postpone a discussion based on the belief that the subject is too difficult for the patient to comprehend. While it is true that education is unique for each patient and that emotions can interfere with the discussion, the discussion should not be postponed

99. A patient requires limit-setting by the RN. In accomplishing this intervention, what statement will the RN make? a. "You are not following the rules." b. "Here are the unit rules; let's review them." c. "Your behavior is bad." d. "How many times must I repeat the unit rules?"

B - Expectations and rules may have to be reviewed and/or reinforced as a part of limit-setting. The remaining options are very harsh and judgmental, thus creating a nontherapeutic environment.

25. In some patients diagnosed with schizophrenia, blood flow in the frontal lobe is diminished. The nurse would expect such a patient to experience which deficit? a. Inability to recall a telephone number b. Ineffective at planning a family birthday party c. Poor boundaries when socializing with strangers d. Difficulty balancing when riding a bike

B - Frontal lobe blood flow deficits limit critical thinking, planning, and organizing. Memory, associating social boundaries, and physical balance would not be affected by such a condition since those functions are not centered in the frontal lobe.

58. The patient asks, "Why is it necessary to ask me so many questions?" How should the nurse best response to the patient's question? a. "So we can help solve your problems here." b. "Questions are asked to understand the concerns you have." c. "It is important that you and I become friends." d. "We are required to ask you questions as part of your therapy."

B - Identifying the patient's concerns is necessary to care for the patient therapeutically. This response accurately answers the patient's question and places the nurse alongside the patient in the therapeutic relationship. Problems are not solved or "fixed"; rather, the nurse is available to assist with healing and support the patient's independence and autonomy in planning and problem solving. Being friends is social rather than therapeutic in nature and is a possible professional-boundary violation. Therapeutic relationships are a purposeful choice rather than being forced or required.

26. Which neurotransmitter is most widely associated with the biologic theory for the development of Parkinson disease (PD)? a. Norepinephrine b. Dopamine c. Serotonin d. Acetylcholine

B - In Parkinson disease (PD), dopamine is reduced by death of dopamine releasing cells in the substantia nigra. Without the excitatory effect of dopamine to the striatum, more pallidal firing reduces thalamic activity. Cortical activating effects are reduced, with decline in initiating and executing motor activity, causing bradykinesia, and disinhibition of muscular control, causing resting tremor, rigidity, and loss of postural reflexes. This theory regarding the cause of PD is not associated with norepinephrine, serotonin, or acetylcholine.

42. When the nurse is employing spiritual care for a patient, it is most important to display what? a. One's own beliefs as a guide b. Trust and compassion c. Direction and control d. Willingness to make referrals

B - Meeting the patient's needs with both trust and compassion honors the patient while supporting the intrinsic needs of the patient with beliefs of faith. Basing care on one's own belief system may indicate countertransference and may not be congruent or supportive of the patient's beliefs. Being controlling and directive is nurse-focused care and not patient-centered care. Care should allow patient direction and control. Referrals are important but do not stand alone as the only intervention.

64. The nurse demonstrates an understanding of the impact of physical considerations on a patient's ability to communicate effectively when implementing which intervention? a. Asking a crying patient if he or she is sad b. Assessing a patient's pain level c. Monitoring an angry patient for an increase in pacing d. Recognizing the importance of a patient's body language

B - Patients with certain physical problems might experience communication difficulties. Acute physical pain often interferes with patients' abilities to think clearly and concentrate. Characteristics associated with body language such as crying and angry pacing are considered kinetic in nature.

46. A chronically depressed, suicidal patient asks the nurse to arrange for a clergy visit. Which referral demonstrates the nurse's understanding of making an effective choice? a. The patient's personal clergy b. The multidisciplinary team's chaplain c. A clergy with an interest in counseling the mentally ill d. The clergy member whom the family identifies

B - Patients with spiritual concerns should be referred to a clinically trained spiritual care professional (usually a chaplain), and this person should be part of an interdisciplinary health care team. Community clergy, even those with an interest in the mentally ill, are usually not trained to address the spiritual needs of psychiatric patients. Family members can be biased in their selection of clergy.

53. What intervention should the nurse focus upon when considering the key nursing component of any therapeutic treatment model? a. The patient's readiness to engage in therapy is assessed. b. Facilitate the development of a therapeutic patient-nurse relationship. c. Assess the extent to which the patient utilizes involuntary defense mechanisms. d. Monitor the patient's maladaptive behaviors.

B - Psychiatric nurses recognize that the key component in any therapeutic model is the patient-nurse relationship. The therapeutic alliance is often the best predictor of the outcome of any treatment approach. Patient readiness and reliance on involuntary defense mechanisms, as well as nursing knowledge, are components that determine treatment success, but none of these have as much impact on therapeutic outcomes as does an effective patient-nurse relationship.

35. What statement demonstrates an understanding of the key to an ethnically diverse patient's ability to recover from physical and emotional illness? a. "The first assessment data I collect is the age and general health of the patient." b. "The delivery of culturally competent health care is fundamental to effective care." c. "It's vital to include the family into the care of the patient." d. "Initially, I need to determine the amount of confidence the patient has in Western medicine."

B - Research on the use of culturally competent mental health strategies has indicated that cultural competence is key to patients' recovery process. While age, health, family support, and confidence in medical treatment are factors, they are not the primary factor in a patient's recovery.

31. Which statement best demonstrates a nurse's understanding of cultural competence in nursing practice? a. "I try to treat all my patients the same to avoid biases." b. "I ask my patients to teach me what works best for them." c. "I always ask patients to trust me to care for them appropriately." d. "I think each patient reacts basically the same way to psychiatric medications."

B - Seeking the patient's involvement demonstrates a cultural awareness that facilitates the nurse's understanding of the patient's cultural need. It is not realistic to treat everyone the same given individuality, uniqueness of the human experience, and cultural variations and diversity. The patient is not expected to give up control of their care regardless of their cultural background. It has been proven by research that ethnic groups do react physically differently to medications in many instances.

28. What assessment question focuses on a characteristic associated with the potential long-term effect of childhood trauma and maltreatment? a. "Do you consider yourself a student?" b. "Have you ever been diagnosed with chronic depression?" c. "Do you ever hear voices others don't seem to hear?" d. "Do you find yourself having trouble remembering dates?"

B - Significant stress, trauma, maternal behavior, and maltreatment during childhood and adolescence are mental health issues, because they have the potential to permanently alter the structure and chemistry of the brain, which often leads to a life of depression and anxiety. There is currently no research to associate these events with impaired cognition, schizophrenia, or dementia/memory.

100. To best achieve implementation of balance on an inpatient acute-care unit, which statement the RN make to the patient? a. "Are you feeling suicidal?" b. "How about taking a walk with the group now?" c. "Did you sleep well last night?" d. "When will your family arrive today?"

B - Suggesting that the patient take a walk with the group is an appropriate example of facilitating independence within the context of being dependent. Monitoring for suicidal thoughts is associated with safety. Monitoring sleep and asking when family will arrive are not related to milieu management.

104. The characteristics of a therapeutic milieu are constantly being changed as a result of demands created by which treatment-related factor? a. The severity of the symptoms displayed by the patients. b. The short hospital stays of today's mentally ill patients. c. The different treatment goals identified by the multidisciplinary team. d. The degree of aggression demonstrated by the patients.

B - The constant change and demands associated with a rapid turnover of patients requires nurses to continuously reevaluate the environment in tandem and in co-ordination with the entire multidisciplinary team. The degree of aggression and severity of symptoms are factors considered but are not the cause of the need for constant milieu evaluation.

59. When a patient discloses a history of chronic trauma to the nurse, what therapeutically response should the nurse provide? a. "I think everything will be okay." b. "This is difficult to talk about; I'm here to help." c. "How long did that go on?" d. "I know you will be feeling better soon!"

B - The correct response demonstrates the nurse's interest, concern, and availability to the patient. It is nontherapeutic to provide false reassurance. Focusing on when the event occurred is act-based but not supportive of the patient in this context.

12. When considering the goals of deinstitutionalization, nursing staff will focus on which policy topic? a. The staffing of in-hospital treatment centers b. Criteria for involuntary commitment c. Analyzing the cost of in-hospital mental health treatment d. Identifying the type of training required of mental health care providers

B - The deinstitutionalization movement brought about a change in commitment laws. Out of concern for the civil rights of mental patients, involuntary commitment of individuals to a state hospital became difficult. The state had to demonstrate that those accused were a clear danger to themselves or to others. Neither staffing, cost of hospitalization nor the training required of health care providers was significantly affected by this movement.

55. By what means does an individual typically cope with anxiety that is overwhelming? a. Acting out b. Defense mechanisms c. Psychosis d. Transference

B - The ego usually copes with anxiety through rational means. But when anxiety is too painful, the individual copes by using defense mechanisms to protect the ego and diminish anxiety. Acting out, such as with physical aggression, and psychotic behavior may be seen as the outcome of an individual's inability to cope with anxiety, but they are not the typical coping mechanism used. Transference is the act of distorting personal perception of others by attributing to them qualities they do not possess.

67. The nurse practicing with therapeutic intentions versus social ones will engage in what action? a. Offering to visit the patient following discharge b. Assessing the patient's needs following discharge c. Ignoring the patient's requests for a date while on the unit d. Feeling sad and crying in response to the patient's depression

B - The establishment and maintenance of objectivity and goal-directedness is crucial in therapeutic relationships. Assessing patient needs in preparation for discharge demonstrates therapeutic intentions. Offering to visit the patient following discharge is an example of blurring boundaries and the risk of unprofessional conduct that may come as a result. Inappropriate social requests should not be ignored but should be discussed with the team for decision-making purposes. Crying and feeling sad in response to a patient's condition may suggest a potential for a boundary violation as an example of countertransference.

85. In beginning work with a dysfunctional family, the RN initiates the assessment by asking what question? a. "Where would each of you like to begin?" b. "How would you like your family to change?" c. "What kinds of problems do you have?" d. "Why are you here?"

B - The nurse begins the time together by identifying high priorities for each member in relation to changes desired by the members. Allowing the members to control the assessment would not provide the focus and direction the assessment requires. "Problems" may not be a factor; language used more therapeutically and with positive/hopeful intent would be more therapeutic in nature "Why" is abrupt and may place the family members on the defensive initially in the relationship.

65. When considering communication, what is the initial intervention required of a nurse responsible for the care of a newly admitted patient? a. Providing an introduction that includes one's name and professional role b. Self-assessing for possible barriers to effective communication with the patient c. Conveying respect and caring when engaging in the initial nurse-patient conversation d. Allowing the patient to determine the focus of the initial nurse-patient communication

B - The nurse must recognize and overcome any habitual communication problems that might interfere with effective therapeutic communication. After such a self-assessment is made and the needed corrections are made, an informative introduction can be made that is followed by a respectful, caring conversation that is nurse-directed but patient-focused.

6. A patient recovering drug addict is being prepared for discharge to residential housing. In order to best meet ongoing recovery needs, nurse should be prepared to discuss which type of residential housing service with the patient? a. Group home b. Halfway house c. Boarding home d. Foster care house

B - Traditionally, halfway houses are available for individuals recovering from chemical dependency. Residents were expected to seek employment and participate in cooking and cleaning chores. Residents also attended self-help groups that met on site, such as Alcoholics Anonymous. Group homes might provide temporary or permanent housing for individuals with chronic mental disorders. Foster care and boarding homes are generally staffed by nonprofessionals but have professional supervision available on an intermittent basis

79. What is the expected therapeutic outcome when a group leader asks a group member to clarify the statement he or she just made? a. The leader and the group member will enter into an exchange of information. b. The group member will become aware of the need to be more precise when giving information. c. The group member will begin to take responsibility for the information given by him or her to the group. d. The leader identifies topics that need the attention of the group.

B - When the leader seeks clarification, the member becomes aware that he or she was not clear and learns to identify thoughts and feelings more precisely. Information seeking results in an exchange of information. Encouraging description results in the members taking responsibility for the information they provide. Focusing involves the identification of topics that require the group's attention.

48. How can a nurse best provide patient-focused spiritual care? (Select all that apply.) a. Ask the patient to be allowed to pray with him or her. b. Take a spiritual history as part of the assessment interview. c. Support the patient's spiritual beliefs. d. Always address the patient with kindness and respect. e. Be ready to respond to a patient's request for a pastoral care referral.

B, C, D, E - Nurses should do five things regarding spiritual care: (1) Take a spiritual history; (2) support and show respect for the patient's beliefs; (3) pray with the patient if the nurse is comfortable doing so and if the patient wants and requests it; (4) provide spiritual care by being kind, gentle, sensitive, and compassionate; and (5) refer to pastoral care if desired by the patient.

49. Which statement made by the nurse demonstrates an understanding of the developmental approach to working with a patient? a. "What are the challenges with the relationship between you and your partner?" b. "What usually happens when you become angry?" c. "Whom would you trust to manage your business affairs?" d. "You say you want to lose weight, yet you spent all your money on fast food."

C - Assessment of Erikson Developmental Theory is associated with trust-versus-mistrust mastery. Interpersonal Theory (Sullivan) focuses on relational issues for the patient. Assessment of the patient's appraisal of the stress/coping response (Lazarus) would be associated with assessing anger. A statement by the nurse about the patient's maladaptive response in spending money on fast food, pointing out irrational thoughts leading to maladaptive behaviors, would be associated with the cognitive approach.

78. The registered nurse (RN) is leading a group on medication teaching with a diverse group of outpatients. One participant is attentive but does not speak. Which question asked by the RN would be most appropriate to encourage this participant to contribute to the group process? a. "What would you like to add?" b. "Can you share with the group about your medications?" c. "What have you learned in this group that has been helpful to you today?" d. "Why have you been so quiet today in group?"

C - By inviting involvement without threatening the patient, the nurse encourages and facilitates contribution and feedback. Requiring the patient to "add" to the discussion is too broad, while requiring the patient to talk about a specific topic may be interpreted as being threatening. Asking the patient to explain his or her behavior risks placing the patient on the defensive and does not foster the nurse-patient therapeutic relationship.

63. What is the initial purpose for the nurse determining a patient's content themes? a. Initiation of discharge planning b. Formulating long-term patient goals c. Identifying underlying patient messages d. Selecting fitting nursing interventions related to mood

C - Content themes go beyond the words that a patient is saying and examine underlying messages about patients' perceptions of themselves and their problems over time. Their messages relate to beliefs and values, self-concept and self-esteem, a sense of helplessness and hopelessness, suspiciousness, risk for suicide, and disturbances in thinking or processing of information and beliefs. Mood themes relate to affect and the feelings conveyed while patients discuss their issues and concerns.

102. To provide paternalistic care implies that the nurse bases nursing interventions on which belief? a. The patient wants the nurse to make the decisions. b. The patient is incapable of making appropriate decisions. c. The nurse making the decisions knows what is best for the patient. d. The nurse works with the patient to arrive at decisions regarding care.

C - Custodial care was a paternalistic system in which the staff knew what was best for the patient. Few attempts were made to allow the patient to participate in his or her own treatment. The patient may not want to give up all control and should be allowed input to the degree that he or she is capable of making sound decisions.

91. Which nursing intervention will best enhance the at-risk family's ability to function and prevent the occurrence of mental health problems? a. Regularly scheduled therapy sessions b. Depression screenings for all family members c. Appropriately focused preventive family education d. Identifying the member who has assumed the role of scapegoat

C - For at-risk families, preventive education can enhance functioning and prevent the occurrence of mental health problems. While therapy, mental health screening, and effective assessment are important factors in assisting the family, the most effective means of minimizing risk of dysfunction and the development of mental health problems is to educate the family members appropriately.

81. What is the most negative outcome when hostility expressed by a group member is allowed to go unchecked? a. The remaining members also become hostile. b. The leader loses credibility with the remaining group members. c. The group's ability to focus on its work is negatively affected. d. The hostile member begins to assume the group's leadership role.

C - Hostility might mask a patient's fear, self-anger, or unresolved anger toward others. Allowing verbal or nonverbal hostility to continue jeopardizes the progress of the group session. While the other members may become hostile, it is more likely that they will emotionally retreat from the group. The leadership role can become blurred, but the greatest negative impact is the group's inability to function effectively.

76. What is the initial intervention when a patient acknowledges to the nurse that he is hearing voices? a. Minimizing stimulation by moving the patient to an area that is quiet and dimly lighted b. Seating the patient in front of the television so the program can serve as a distraction from the voices c. Asking the patient to describe what the voices are saying d. Reassuring the patient that the staff will keep him safe

C - If the patient acknowledges hearing something that the nurse cannot hear, the nurse can then ask, "Tell me what you hear." Moving the patient to a low-stimuli area will not serve to help control the voices. The voices from the television are not likely to serve as a distraction. Reassuring the patient that staff will keep him safe is not necessarily inappropriate, but the need for safety cannot be determined until it is known what the patient is hearing.

69. A patient experiencing a loss of reality believes in the angry voices in her head. The nurse should initially respond to a newly admitted patient who is experiencing auditory hallucinations by making which response? a. "There are no voices in your head." b. "Try to ignore them by listening to your favorite music." c. "While I don't hear voices, I believe that you are." d. "Just listen to my voice to distract yourself."

C - Initially the nurse acknowledges and respects the patient's experience while presenting reality and avoiding reinforcement of the hallucinations. Stating that there are no voices discounts and minimizes the patient's experience. It is nontherapeutic and may be argumentative. More teaching and support of the patient will be required before distraction can be implemented, and even then it may not be possible or realistic for the patient.

88. Which situation is addressed by families in the launching stage of development? a. Assimilating new children as members b. Sending their oldest children to school c. Attending the marriages of their children d. Adjusting to life without children in the family

C - Launching is centered around the children leaving the family to start independent lives, whereas children are introduced into the family during the early childbearing stage. Sending children to school occurs during the stage of schoolchildren, whereas adjusting to life without children occurs during midlife.

107. What intervention is met by occupational therapy specialists? a. Identifying the role of social support groups b. Understanding the early symptoms of relapse c. The successful completion of activities of daily living d. The need for hope and its effect on recovery and remission

C - Occupational therapists are trained professionals concerned with the functional abilities of patients as they affect their capacity to work and perform tasks of daily living. Psychoeducation involves educating patients and families regarding symptom recognition and management. The goal of psychoeducation is to provide social support and share information relevant to the mental disorder so that patients can adapt to living with a chronic illness and find ways to remain stable. Spirituality groups help to instill hope and encourage patients to begin looking at their faith and spirituality as potential resources in their recovery.

9. When teaching colleagues the concept of community-based care, which statement will the nurse make? A. "The greatest challenge is to work with those identified as the worried well." B. "Homelessness is the root of all mental illness." C. "A seamless continuity of care for the mentally ill individual is a favorable goal." D. "When treating the chronically mentally ill, it is best to wait for a crisis to occur before intervening with treatment."

C - Providing care for those seeking services for mental illness should serve to support independence and autonomy and be delivered with the least amount of restriction. This is the goal of community mental health care. Working with the worried well is less intense and may actually preoccupy mental health care providers and keep them from working with the severely mentally ill. Though many homeless individuals may suffer from mental illness, homelessness does not cause mental illness. Mental health promotion and disease prevention is most respectful, least stressful, and more cost-effective.

41. A novice nurse shares being uncomfortable speaking with patients about religion and spirituality. Which statement by the nurse manager responds most effectively? a. "It's okay to avoid bringing up this issue with chronically mentally ill patients." b. "If a patient brings it up, then listen, but you need not initiate the conversation." c. "A simple strategy is to ask them about their faith community." d. "Let's discuss why you're uncomfortable discussing religion and spirituality."

C - Providing the novice nurse with a simple, relevant, and respectful assessment question to initiate the conversation is the most effective response. It is not okay to avoid the issue; patients have spiritual needs and deserve support in this area of care. It is professionally appropriate to initiate a conversation with a patient, unless it is nontherapeutic for a particular patient and his or her current thought processes. "Why" serves to place the staff member on the defensive; this is an important question deserving of an educated, professional response.

105. Which intervention will best address the nursing goal of maintaining unit safety while decreasing the use of limit-setting? a. Patients who are disrespectful to other patients or staff lose telephone privileges. b. As a patient's depression lessens, he or she is encouraged to engage in unit activities. c. At admission each patient will be given both an explanation of and a copy of the unit rules. d. The newly admitted patient is introduced to the unit's daily schedule of group sessions and activities.

C - Specific means of decreasing the use of limit-setting involves an attitude of making unit rules and expectations clear, as well as encouraging patients to take responsibility for themselves. Key concepts that support this strategy involve patients being advised of unit rules upon admission and at frequent intervals, depending on their capacity to comprehend and attend to these rules. Written copies of unit rules should be provided to each patient and posted on the unit in a highly visible location. Norms are specific expectations of behavior that permeate the treatment environment; they are intended to promote safety and trust in the environment through the sanctioning of socially acceptable behaviors and consistency about what to expect. Balance involves the process of gradually allowing independent behaviors in a dependent situation. Structure refers to the physical environment, daily schedules of treatment activities, and informal rules of interacting between patients and staff.

71. A newly admitted patient is depressed and fears her husband will ask for a divorce and begins to cry during the initial assessment interview. What nursing strategy should the nurse consider? a. Postponing the assessment for later b. Avoid commenting on her tears, and continue the assessment c. Temporarily stopping the assessment to offer her a tissue d. Asking her why her husband wants to divorce her

C - Stopping to offer the patient a tissue allows the patient (and the nurse) to pause, think, and collect herself. Assessment initially may not be postponed; data forms the basis for the plan of care, and the nurse-patient interaction initiates or establishes the therapeutic relationship. Making the observation is therapeutic and validates support of the patient. "Why" questions are considered nontherapeutic and could engender anger and/or defensiveness

70. A new registered nurse (RN) reports experiencing difficulty knowing how to terminate a relationship with a patient. What response should the nurse's preceptor make to address the nurse's concern? a. "If the relationship has been short, termination may not be necessary." b. "Just say good-bye and good luck." c. "Thank the patient for working with you, and say how you valued the experience." d. "Try to move through the termination phase as quickly as possible."

C - Thanking the patient and acknowledging the value of the experience offers respect and support to the patient while validating the importance of the relational opportunity for the nurse. Termination is always appropriate and necessary therapeutically. Wishing the patient "good luck" is not therapeutic, but instead is casual and informal. Termination should not be rushed, and—depending upon the length of time in the relationship—planning and discussion of termination for the patient and nurse are important.

18. Which statement made by the nurse accurately demonstrates knowledge of the M'Naghten rule and its impact on the mentally ill? a. "All mentally ill individuals are assured the right to treatment." b. "Nonviolent mentally ill individuals have the right to refuse treatment." c. "An individual declared to be in same cannot be held legally accountable for a murder." d. "Any threat of violence toward another made by a mentally ill individual to a health care professional must be reported."

C - The M'Naghten rule states that individuals who do not understand the nature and implications of murderous actions because of insanity cannot be held legally accountable for murder. Wyatt v. Stickney, 344 F Supp 373 (MD Ala 1972), confirmed a right to treatment. Rogers v. Okin, 478 F Supp (D Mass 1979), determined the right to refuse treatment. In this case, the ruling prohibited Boston State Hospital from forcing nonviolent patients to take medications against their will. Tarasoff v. The Regents of the University of California (1976) 17 Cal 3rd 425, ruled that mental health professionals have a duty to warn of threats of harm to others.

87. What is a basic concept of family systems theory? a. Parents are the primary elements in the family. b. Nuclear families are more likely to be dysfunctional than extended families. c. A change in one member will cause changes among the other members. d. Economics rather than divorce is the most common cause of family dysfunction.

C - The family is conceived of as a collective unit made up of individual parts with every family member playing a critical, albeit unique role in the system. It is not possible that one member of the system can change without causing a ripple effect of change among the other family members. Parents are no more important than any other family member when considering dysfunctional behaviors. All forms of families are equally prone to dysfunction, with divorce and economics being some of the negative factors responsible for family dysfunction.

56. Which mental health model has stated principles that include the belief that individuals work to improve their own health and wellness? a. Recovery b. Psychoanalytic c. Developmental d. Interpersonal

C - The first principle of the recovery model is that it is person-driven. The psychoanalytic model is focused on a more relationship-oriented self-psychology and on object relations theory. The essence of self-psychology is that every human being longs to be appreciated. The developmental model states that the drive of humans to live and grow is opposed by a drive to return to more comfortable earlier states and behaviors. Interpersonal disputes and role transitions often occur in family, social, or work settings; there may be differing outlooks and expectations.

45. What characteristic of schizophrenia poses a negative effect on the patient's spiritual perspective? a. Hallucinations b. Delusions c. Concrete thinking d. Paranoia

C - The incapacity to symbolize—that is, the patient's concrete thinking—can cause special problems, because it is believed that religious language is symbolic by its nature. While hallucinations, delusions, and paranoia present the patient with severe problems, they are not as influential as concrete thinking on the spiritual life.

36. What question should the nurse ask to assess for the most common barrier to the delivery of culturally competent nursing care to a client diagnosed with depression? a. "Do you feel ethnic prejudices contribute to your depression? b. "Can you identify any religious biases you have? c. "Please tell me what you learned about your antidepressant medication? d. "Have you ever been a victim of racial discrimination?

C - The most common barrier to the delivery of culturally competent nursing care involves miscommunication between nurses and patients. While prejudices, biases, and discrimination occur, they are not the most common barrier to the delivery of culturally competent nursing care.

90. How can the nurse best assist families in learning healthy coping skills? a. Become familiar with the techniques used in family therapy counseling. b. Use effective assessment skills so as to identify the family's problems. c. Nurture healthy relationships with his or her own family and friends. d. Recognize that all families have both strengths and needs.

C - The nurse must model adaptive self-care and stress management techniques, such as strong support and nurturing from friends and family. Such self-care activities prepare the nurse to assist patients and families in learning healthier coping skills to manage their lives. While a nurse needs to understand the characteristics of families and to possess effective counseling and assessment techniques, self-reflection and the ability to model healthy behavior will have the greatest impact on assisting families in crisis.

75. Which statement made by the nurse indicates a need for additional instructions concerning the nursing role in promoting a change in a patient's behavior? a. "How long do you think it will take for you to stop smoking?" b. "You should be very proud of the way you handled your anger today." c. "I think you will be much happier when you leave your abusive partner." d. "What do you think you can do to avoid the triggers that cause you to abuse alcohol?"

C - The nurse should not give the patient advice to leave but rather help the patient solve her own problems. The nurse encourages short-term, realistic, and achievable goals that have been made by the patient. Asking the patient to consider timelines, praising the patient for positive changes, and helping with the identification of triggers are all appropriate nursing interventions that focus on the promoting of change.

4. Considering the environmental elements a nurse must consider when creating a therapeutic milieu, which intervention has priority? a. Providing instructions on the use of the unit's washer and dryer so the patient can be responsible for personal laundry b. Reminding a patient that aggressive behavior toward staff and other patients will not be tolerated c. Informing the family that a depressed patient may only have slip-on style shoes d. Posting a written calendar of all groups and activities scheduled for unit patients

C - The six environmental elements that nurses must consider in creating a therapeutic milieu include safety, structure, norms, limit-setting, balance, and modification. Safety, such as monitoring a depressed patient's personal belongings for possible dangerous elements, has priority over all other considerations. Supporting a patient in managing his/her own laundry is associated with balance, while reminding a patient that aggressive behavior is not permitted relates to limit-setting. Providing a unit schedule supports the patient's need for a structured environment.

27. Which characteristic would support a diagnosis involving an impaired limbic system? a. Laughing when observing another person crying b. Lacking evidence of empathy c. Lack of appropriate response to offensive odors d. Failure to note severe bleeding from a wound

C - The temporal lobes are divided into pre-olfactory and olfactory areas for odor detection and processing, with connections to the limbic system for corresponding emotional responses. Prefrontal areas such as the orbitofrontal cortex and cingulate gyrus modulate emotional responses by inhibiting socially inappropriate impulses, promoting empathy, and monitoring the environment for salient cues and stimuli.

54. Considering the psychoanalytic therapy model, which intervention is a major nursing therapeutic responsibility? a. Using free association to bring repressed thoughts to consciousness b. Interpreting the patient's dreams c. Helping the patient identify maladaptive behaviors d. Assessing the patient for mastery of developmental tasks

C - To support the psychoanalytic therapy model, the nurse must recognize and understand the maladaptive defense mechanisms that patients use. The nurse carefully shares observations regarding these mechanisms and works with patients to increase awareness about these behaviors to increase adaptive behaviors. It is the therapist's role to use free association (allowing the patient to say everything that comes to mind) so that repressed material can be identified and interpreted for patients. Dream analysis by the therapist helps patients uncover the meaning of their dreams, which also increases awareness about present behavior. In the developmental therapy model, the nurse conducts an assessment of the patient's level of functioning through the interpretation of verbal and nonverbal behaviors and identifies the degree of mastery of each stage up to the patient's chronologic age.

43. The psychiatrist Viktor Frankl is known for which observation regarding spirituality? a. People demonstrate characteristics of either healthy spirituality or sick religiosity. b. Spirituality is the sum total of intellectual and cultural possession. c. While we cannot always choose our circumstances, we can choose our attitudes about our experiences. d. Spirituality gives life, depth, and meaning to existence.

C - Viktor Frankl was a notable psychiatrist who experienced intense suffering as a prisoner in Nazi concentration camps during World War II. He recognized that, although individuals cannot always choose their circumstances, they always have a choice about their attitudes toward their experiences. Xavier (2008), a clinical psychiatrist, offers a useful distinction from his psychiatric experience between "healthy spirituality" and "sick religiosity." Jung described spirituality as "the sum total of intellectual and cultural possessions. . . ." It was also Jung who proposed that spirit refers to something not strictly physical, which gives life, depth, and meaning to existence.

19. Under what circumstances can a nurse take action to prevent a mentally ill patient from leaving the hospital where treatment is being rendered? a. The patient is diagnosed with a chronic mental illness. b. The treatment goals for the patient have not yet been achieved. c. The interdisciplinary team agrees that the patient still needs treatment. d. The patient was committed by the court for mental health treatment

D - A patient committed by a court proceeding can be prevented from leaving a facility, and doing so is legal and thus cannot be considered false imprisonment. A patient cannot be forced to remain in a hospital for treatment based solely on diagnosis, achievement of goals, or the need for treatment.

110. A patient being discharged from a co-occurring-disorders psychiatric unit will especially benefit from what area of patient education? a. Healthy eating habits b. Effective exercise routines c. The importance of medication compliance d. The role of the community-based treatment facility

D - After patients are stabilized both medically and psychologically, they are referred to co-occurring-disorders programs in the community setting to provide the additional support they need to meet the challenges of their dual diagnoses. The remaining options are all appropriate but not especially focused on the needs of this population.

40. What assessment question should the nurse ask to best support an individual's spirituality? a. "Which church do you attend?" b. "Are you a religious person?" c. "Would you like a consult with the chaplain?" d. "What spiritual needs do you have right now?"

D - Asking the patient to identify their spiritual needs using an open-ended question begins the assessment process. This question is inclusive of a variety of belief systems while honoring and respecting the individual's values and acknowledging spiritual needs. It is inappropriate to assume an individual attends a church. Asking if the person is religious is a closed-ended question and can be viewed negatively by the person. Asking whether a chaplain consult is desired is a closed-ended question that proffers the nurse's values and can be considered as disrespectful by the individual.

86. A family experiencing crisis comes to the mental health clinic in response to an adolescent running away from home. The nurse will initiate the assessment by asking what question? a. "Here is information regarding a support group in the community." b. "Does your family fight a lot?" c. "Has this ever happened before?" d. "How have you managed similar family issues?"

D - Assessing the family's usual coping strategies, whether or not successful in the past, will set the stage for assessment and teaching needs. The nurse should avoid passing off the family initially but should complete the assessment, offer support, and then consider the use of community resources and support. Closed-ended questions and those framed in a negative/deficit manner are nontherapeutic.

80. How should the nurse provide a cathartic environment during a group session? a. Starting and ending the group sessions at the agreed-upon times b. Role-modeling appropriate social skills for the group's members c. Recognizing members for their supportive attitudes toward others in the group d. Providing the opportunity for each member to express his or her feelings

D - Catharsis requires that patients be allowed to express feelings as well as being taught how to do so effectively. Keeping to the previously agreed-upon rules is important but is not related to catharsis. Members develop social skills through the role-modeling of the leader. Acknowledging supportiveness among members encourages interpersonal learning.

108. Which statement incorrectly describe a child-adolescent inpatient unit? a. It manages the care of patients between the ages of 2 and 17 years of age. b. Its focus is short-stay treatment. c. Patients have varied forms of mental illness. d. Patients are stabilized before being admitted.

D - Child-adolescent inpatient units offer comprehensive psychiatric assessment, stabilization, and short-stay intensive treatment to children and adolescents between the ages of 2 and 17 who suffer from complex psychiatric conditions. Common conditions that are treated on these units include severe depression, bipolar disorders, impulse-control disorders, phobias and other anxiety disorders, schizophrenia and other psychotic disorders, and eating disorders.

95. Which pharmacodynamic effect related to downregulation should the nurse discuss with a client prescribed an antidepressant? is thought to be responsible for? a. The desired mood elevation will require an increase in dosage. b. The medication can decrease the effectiveness of other prescribed drugs. c. The effectiveness of some previously prescribed medications will be increased. d. The 2- to 4-week period required for antidepressant medications to affect mood.

D - Downregulation of receptors is an important concept, primarily because chronic exposure to certain psychotropic drugs causes receptors to change. Consistent use of antidepressants causes postsynaptic receptors to decrease in number. Because this down-regulation occurs at about the same time that the antidepressant effect develops (approximately 2 to 4 weeks), it is thought by some that reduction in postsynaptic receptors might provide a better explanation for mood elevation than increases in neurotransmitters. Pharmacodynamic tolerance is a term used to describe a reduction in receptor sensitivity (or desensitization). The affected receptors are no longer responding to the medication in the way a normal person's receptors would respond. Pharmacokinetic interactions occur when one of the four pharmacokinetic processes is inhibited or induced, while pharmacodynamic interactions relate to the synergistic or additive effect drugs have on each other. Neither process is relevant to the effective time frame of antidepressant medication.

74. Which statement demonstrates empathy on the part of the nurse responding to a patient who is angry about the death of her child? a. "I lost a child too, so I know how you feel." b. "It is a pity that someone so young was taken from you." c. "You have a right to be angry, losing a child is so unfair." d. "It's normal to be angry, but let's talk about how to handle that anger."

D - Empathy is an objective understanding of the way in which patients see their situation. It can also convey hope for improvement. Sympathy, by contrast, is the nurse having the same feelings as the patient, and objectivity is therefore lost. Sympathy often leads to comforting, reassuring, or pitying patients.

84. When severe mental illness is experienced by a member of a healthy, functional family, the RN would expect to hear what statement made by a family member? a. "We're trying not to think about this devastating experience right now." b. "This is terrible news. How could this happen to our family?" c. "It will be good to have this problem fixed soon." d. "We will face this together and ask for help right away."

D - Facing situations together and understanding when help is needed reflects cohesion, positive movement, and active involvement in the treatment process—all characteristics of a functional family. Denial and compartmentalization would not be productive or utilized in a healthy, functional family. Viewing a situation as terrible is an example of shock and disbelief for the family that is characteristic of dysfunctional families. Severe mental illness is not "fixed," but rather "treated"; the family member would hopefully experience recovery and healing over a period of time (not necessarily "soon").

83. What is the rationale for placing chairs in a circle configuration for seating during a support group session? a. It allows the leader to easily monitor the participation of the members. b. It minimizes disruption when members enter or leave the session. c. It supports redirecting by the leader when the members lose focus. d. It supports the expectation that all members are to interact with each other.

D - Forming a circle of chairs allows patients to see each other and indicates an expectation that patients will relate to the leader and other group members.

16. In implementation of the principle of "duty to warn of threatened suicide or harm," what is the nurse's initial action? a. Seeking guidance regarding confidential client information from the agency's attorney. b. Directing all questions to the psychiatrist in charge of the patient c. Notifying third parties whenever there is a concern of harm from the patient. d. Notifying the multidisciplinary team regarding communication of client information.

D - Involve the team in discussion and decision making regarding threats; avoid working in isolation. While there may be a need to consider consulting with the agency's attorney as well in some situations, his or her team will need first discussion and problem solving prior to contacting the agency's attorney for guidance. The team, along with the psychiatrist working with the patient needs to discussion the issue. The third-party notification is dependent upon the discussion by the team.

106. When considering the elements required of the treatment environment, which statement addresses the need for norms? a. Includes daily schedules and informal rules. b. Involves measures to ensure physical and psychological protection. c. Supports independence even when the patient is dependent. d. Provides predictability to all patients.

D - Norms create an environment that is predictable and applicable to all patients. Structure refers to the physical environment, daily schedules of treatment activities, and informal rules of interacting between patients and staff. Safety is primary to all other aspects of the environment. Safety involves both physical and psychological protection. Balance involves the process of gradually allowing independent behaviors in a dependent situation.

68. A newly admitted patient continually touches the nursing staff members and makes sexual innuendoes when interactions are attempted. The initial therapeutic manner of managing such behavior is demonstrated by what nursing action? a. Asking to be reassigned to avoid triggering the behavior b. Demanding firmly that the patient cease all inappropriate touching c. Asking the patient to explain why the sexual innuendoes occur d. Explaining that the behavior is inappropriate and must stop

D - Patients generally stop these behaviors when asked and should be reminded that these actions are inappropriate. The nurse then discusses the underlying need. If the behaviors continue, then setting limits can be stronger. Avoiding the patient without an explanation is incongruent with professionalism. Demands are ineffective and disrespectful. While a discussion concerning the behavior is appropriate, it is not the initial response.

101. A new nurse will best ensure that the therapeutic environment is healthy when he or she verbalizes: which statement? a. "I want to always avoid conflict in the workplace." b. "I believe the team should make important decisions for the patient." c. "I don't think the patients should be busy with activities on the unit." d. "I will closely monitor my own personal values and preconceptions."

D - Self-awareness and insight by the nurse promotes healing and fosters a therapeutic environment. It is not realistic, nor professionally or personally possible, to always avoid conflict. It is a nursing responsibility to support patient independence, autonomy, and decision making. The statement about activities is incongruent with the purposes of therapeutic environment or therapeutic milieu.

51. The nurse who utilizes the cognitive approach in working with a patient might ask which question? a. "How do you relate to the people working with you?" b. "Can you define 'aggression' for me?" c. "Are you comfortable with the way your spouse manages your family finances?" d. "How can you justify eating junk food and trying to lose weight?"

D - Statement by the nurse of patient's maladaptive response, pointing out irrational thoughts leading to maladaptive behaviors, would be associated with the cognitive approach. An assessment of significant relational issues according to Sullivan would be associated with the interpersonal approach. Assessment of the patient's appraisal of the stress/coping response (Lazarus) would be associated with assessing anger. Assessment of Erikson Developmental Theory (trust-versus-mistrust mastery) is associated with trust.

57. Which statement should the nurse initiating communication with a newly admitted client present? a. "Welcome to our unit. My name is David, and I will be your RN today. Do you have any questions? I will not discuss what we talk about with anyone else." b. "My name is Ann, and I will be your nurse this evening. Where would you like to start?" c. "Hello! What is your name? My name is Bruce, and we will work together on your discharge goals. You may tell me anything you would like, because everything you tell me will not be repeated." d. "My name is Sally, and I will be the RN working with you today. I will be sharing our discussion with the care team here only. By what name may I address you?"

D - This statement respectfully addresses all initial concerns: introduction of nurse with name and role, the purpose of the communication, and clarification of confidentiality limits. Closed-ended questions such as "Do you have any questions?" and the sharing of incorrect parameters of confidentiality must be avoided. Initially, the nurse determines the focus of communication.

17. What is the most important component to be communicated regarding legal concerns when reporting to the incoming nursing staff regarding a patient who is admitted for involuntary emergency care? a. The details of the reason the patient was brought to the facility. b. The name of the patient's significant others or advocate. c. Whether or not the patient has been adherent with medication. d. The time and date when the emergency confinement for treatment began.

D - Time is important in assessment, adhering to legal parameters and patient's rights, and preparing the patient for the upcoming options for care. The length of the involuntary status varies from state to state; typically, 48 to 72 hours is the average. The remaining information has importance but is not considered the most important among these options since they don't relate to legal considerations.

92. If a single dose of a drug is given and the drug has a half-life of 4 hours, what percentage of the drug will remain after 16 hours? a. 50% b. 25% c. 12.5% d. 6.25%

D - Using the appropriate calculation of the half-life (length of time required for the body to remove 50% of the medication) for a drug with a half-life of 4 hours, the accurate answer for a single dose of the drug remaining at 16 hours is 6.25%. None of the other answers would be arrived at using the appropriate formula.

3. Which statement made by a nurse demonstrates an understanding of the goal of nursing and its role in psychotherapy? a. "The nursing training provided in the basic nursing program prepares the novice nurse to provide psychotherapy to mentally ill patients." b. "Nursing is the primary source of those prepared to provide the mentally ill with psychotherapy." c. "The primary way a psychiatric nurse can be therapeutic is to provide psychotherapy." d. "The goal of every nursing program is to produce therapeutic nurses to work in combination with psychotherapy.

D - What basic nursing programs teach is how to be therapeutic. Distinguishing therapy from being therapeutic is crucial for the student of psychiatric nursing. Therapy is the focus of graduate-level psychiatric nursing training and graduate programs in other nursing disciplines. It is not taught at the basic nursing program level.

Which statement made by a nurse demonstrates an understanding of Sigmund Freud's contribution to psychiatric care? a. "The client isn't meeting expected developmental tasks." b. "Suicide is often triggered by depression." c. "Stress management is vital to the maintenance of mental health. d. "The medical record suggests the client has an overdeveloped superego."

D- Sigmund Freud introduced terms that have become part of our language: psychoanalysis, id, ego, superego, and free association. His work is not associated with developmental tasks, suicide, depression, or stress management.