Psych Test #2

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

A "What do you think is making you ill?" Asking the client to suggest reasons for the illness will best provide an opportunity to become familiar with general beliefs and values the client holds regarding his wellness.

The nurse recognizes that the client at greatest risk for gender identity disturbances is a A 20-year-old Caucasian male. B 45-year-old Asian male. C 23-year-old Hispanic female. D 30-year-old African-American female.

A 20-year-old Caucasian male. This condition affects males 3 to 4 times more often than females, with the majority being Caucasian and characteristic behaviors peaking between ages 18 and 25.

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

A conditional discharge. An unconditional discharge gives the client complete freedom to choose or reject follow-up care. A conditional discharge imposes a legal requirement for the client to submit to follow-up supervision. REF: Page 101

When interviewing an adolescent client, the nurse can expect the client to be most concerned about the issue of A confidentiality. B sexual orientation. C substance use or abuse. D family mental problems.

A confidentiality. Adolescents are often concerned that what they reveal to the nurse or health care team will be shared with parents. Confidentiality should be explained at the outset of the interview. REF: Page 118

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

A the client's perception of the interviewer's ability to help. Whenever a client is in doubt about the helpfulness of the interviewer, anxiety is generated. The interviewer can "tune in" to the client's anxiety by empathy. REF: Page 116-117

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

A the same as those for any other citizen. Civil rights are not lost because of hospitalization for mental illness.

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

A whether the client has any physical deficiencies. While all the options can interfere, the most prevalent one affecting the data collected is any physical and/or cognitive deficiencies that client may possess. REF: Page 122-123

Regarding the provision of care for clients experiencing sexual disorders, a nurse generalist A helps clients make significant changes in sexual function. B identifies alterations in normal sexuality and relationships. C deals with sexual dysfunctions rather than paraphilias. D offers advice about orgasmic disorders.

B identifies alterations in normal sexuality and relationships. Working in depth with clients with sexual disorders requires advanced education; however, the nurse generalist should be able to identify alterations in normal sexuality and normal relationships and make referrals.

During the initial assessment interview with a psychiatric client, the nurse should regard the spiritual assessment as A optional. B important to complete. C less relevant than the cultural assessment. D relevant only when the client is oriented.

B important to complete. For many clients, religious or spiritual practices are an important part of the quality of their lives. Nurses should support the spiritual dimension of the person. To do so, assessment is necessary. REF:120-121

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

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

An 18-year-old male reports difficulty maintaining an erection. The nurse appropriately assesses this client by inquiring A "When did this problem begin?" B "How does the idea of having sex make you feel?" C "Have you ever had your testosterone levels checked?" D "Are you aware of a history of this problem among the males in your family?"

B "How does the idea of having sex make you feel?" Erectile dysfunction is rare in young men, and the cause is usually psychological rather than physiological.

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

B "What usually helps people who have the same type of illness you have?" Asking about typical treatment seeks information about the "usual" cultural treatment of the disorder experienced by the client.

What ethical principle is supported when a nurse witnesses the informed consent for electroconvulsive therapy from a depressed client? A Beneficence B Autonomy C Justice D Fidelity

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

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

D "Do you expect others to shun or avoid you because you are seeing a therapist?" The question about others' reaction to seeking help from a psychotherapist will not provide data about family dynamics.

A client reports symptoms suggesting a sexual arousal disorder. The nurse appropriately assesses this client for a possible cause by asking A "When did the problem first occur?" B "Is there a specific time of the month when this problem occurs?" C "Are you allergic to any particular foods?" D "Do you take any antihistamine medications?"

D "Do you take any antihistamine medications?" Antihistamines are capable of causing a decrease in vaginal lubrication.

A nurse is interviewing a new client who is angry and highly suspicious. When asked about sexual orientation, the client becomes highly distressed and threatens to walk out of the interview. The nurse responds A "I would like you to stay and answer the question." B "Don't be concerned. I accept homosexuals as well as heterosexuals." C "Your distress leads me to believe you may have something you don't want to discuss." D "I can see that this topic makes you uncomfortable. We can defer discussion of it today."

D "I can see that this topic makes you uncomfortable. We can defer discussion of it today." A cardinal rule of interviewing is "Don't probe sensitive areas." Clients are allowed to take the lead. REF: Page 117-118

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

A 37-year-old patient hospitalized for 6 days; the provider feels one more day would benefit the patient, but the patient doesn't agree and wishes to be discharged Against medical advice discharges are sometimes used when the patient does not agree with the provider, as long as the patient is not a danger to himself or herself or to others. The patient with dementia and the patient who is actively suicidal would pose a safety risk and would be not allowed to be discharged AMA. A patient who wishes to stay in the hospital can make that decision; a family member's opinion doesn't impact an AMA discharge. Text page: 101

What is the common behavior shared by both client and nurse at the beginning of the initial assessment interview? A Anxiety B Biased perceptions C Countertransference D Reliance on supportive confrontation

A Anxiety Both parties feel at least a small amount of anxiety associated with interacting with an unknown person. REF: Page 117-118

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

A Beliefs and values held by people of a given culture about what is good, right, and normal. A worldview is a system of thinking about how the world works and how people should behave in the world and toward each other. It is from this view that people develop beliefs, values, and the practices that guide their lives.

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

A Hospitalization without treatment violates the client's rights. Many years ago psychiatric clients were warehoused in large mental institutions, given custodial care, and rarely released into the community. As enlightenment occurred, it was determined that each client who is hospitalized has the right to receive treatment.

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

A Western biomedicine is one of several established healing systems. A nurse who holds this belief would be likely be open to a variety of established interventions. In truth, nurses cannot apply a standard model of assessment, diagnosis, and intervention to all clients with equal confidence. This leads to culturally irrelevant interventions.

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

A a restraint. Chemical restraints are defined by those medications or doses of medication that are not being used for the patient's condition. Medication time-out is incorrect; false imprisonment and malpractice refer to specific legal terms that do not have any bearing on this medication scenario. Text page: 104

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

A autonomy and beneficence. Autonomy refers to self-determination and beneficence refers to doing good. When a client is restrained or secluded, the need to do good and prevent harm outweighs the client's autonomy. REF: Page 99

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

A autonomy by respecting a client's right to decide to refuse cancer treatment. Autonomy refers to self-determination. Self-determination can be exercised when one makes his or her own decisions without interference from others.

The primary source for data collection during a psychiatric nursing assessment is the A client's own words and actions. B client's family and friends. C client's nonverbal responses. D client's medical treatment records.

A client's own words and actions. The client should always be considered the primary data source. At times, however, the client will be unable to fulfill this role. REF:118

Which ethical principle refers to the individual's right to make his or her own decisions? A Beneficence B Autonomy C Veracity D Fidelity

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

The initial task of an outpatient clinic nurse who is working with a client experiencing a sexual disorder is to A establish trust with the client. B assess the client's physical health. C explain that the nurse is a therapeutic agent. D orient the client to the clinic's programs, which the individual may use as part of therapy.

A establish trust with the client. The initial task in working with any client is to establish trust.

The client who will most likely respond well to drug therapy for the management of compulsive deviant sexual behavior is one whose diagnosis includes A exhibitionism. B antisocial personality disorder. C low sexual drive. D fetishism.

A exhibitionism. Libido and compulsive deviant sexual behavior is best managed pharmacologically in individuals with high sexual drive such as exhibitionists.

In the Eastern tradition, disease is believed to be caused by A fluctuations in opposing forces. B outside influences. C members' disobedience. D adoption of Western beliefs.

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

The psychiatric nurse planning and implementing care for culturally diverse clients should understand A holistic theory. B systems theory. C adaptation theory. D political power theory.

A holistic theory. In most cultures a holistic perspective prevails, one without separation of mind and body.

Health teaching and promotion for a client diagnosed with a sexual disorder is focused on A identifying triggers that produce depression or anxiety. B modifying deviant sexual behaviors. C recognizing the impact of their behavior on others. D reforming their behaviors into more socially acceptable actions.

A identifying triggers that produce depression or anxiety. Health promotion and teaching is directed toward the individual's health and wellness and so identifying triggers for unhealthy outcomes such as depression and anxiety is the focus.

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

A individuals have the right to autonomy to make decisions that affect them. This is the only true statement. The nurse and the client should work collaboratively because each has knowledge to contribute to planning for the attainment of mutually derived outcomes. REF: Page 124-125

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

A is an act or failure to act in a way that a responsible employee would act. Behaving as a wise and prudent person would act under the same circumstances is one way of judging whether the standard of care has been violated. Employers typically hope that staff will prevent clients from striking each other. REF: Page 107-108

In the course of providing best psychiatric care for a client, the nurse must place greatest reliance on A legal principles. B ethical principles. C independent judgment. D institutional standards.

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

According to the Western scientific view of health, illness is the result of A pathogens. B energy blockage. C spirit invasion. D soul loss.

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

The client's priority nursing diagnosis has been established as risk for self-directed violence: suicide related to multiple losses. The priority outcome would be that the client will A refrain from attempting suicide. B be placed on suicide precautions. C attend self-help group daily. D state absence of feelings of powerlessness.

A refrain from attempting suicide. Refraining from suicidal attempts is the only outcome that addresses the risk for self-directed violence. The absence of a feeling of powerlessness is not appropriate for the stated nursing diagnosis. The remaining options are interventions. REF: Page 124-125

Exhibitionism while considered illegal is A seldom a precursor to sexual assault or rape. B generally viewed as a victimless crime. C rarely prosecuted. D generally viewed as an illness by the courts.

A seldom a precursor to sexual assault or rape. Exhibitionism is generally done more for shock value, and actual physical contact is rarely sought.

A client confides to the nurse that she is sexually excited by dominating her partner and achieves orgasm only when she humiliates her partner. The nurse can assess this sexual pattern as A sexual sadism. B orgasmic disorder. C sexual pain disorder. D immature sexual gratification

A sexual sadism. Sexual sadism involves the need to give psychological or physical pain to achieve sexual gratification. REF: Page 393-394

When attempting to determine the cause of low sexual drive in either a male or female client, the nurse can expect evaluation of the client's serum level of A testosterone. B estrogen. C thyroxin. D insulin.

A testosterone. Testosterone, present in both males and females, appears to be essential to sexual desire in both men and women.

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

B If Sophie may cause imminent harm to herself or others A patient may be medicated against his or her will without a court hearing in an emergency if the patient poses a danger to himself or herself or to others. The other options are not legally valid reasons to give medication against a patient's will. Text page: 103

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

B Ms. Wong may feel that she has shamed the family by being fired and may no longer be able to provide for them. Eastern tradition, such as in China, where Ms. Wong is from, sees the family as the basis for one's identity, and family interdependence as the norm. The views expressed in options a and c demonstrate Western tradition where self-reliance, individuality, and autonomy are highly valued. In the Eastern view one is born into an unchangeable fate.

What three structural components comprise a nursing diagnosis? A Problem, outcome, intervention B Problem, etiology, supporting data C Unmet need, goal, outcome criterion D Presenting symptom, treatment, goal

B Problem, etiology, supporting data The components of the nursing diagnosis are problem, etiology, and supporting data. REF:123

Joel is a 43-year-old patient being seen in the mental health clinic with depression. Joel states, "I have always been a practicing Jew, but in the past few months I am questioning everything. I just don't know if I believe in it anymore." Which of the following nursing diagnoses best describes Joel's comment? A Ineffective coping B Spiritual distress C Risk for self-harm D Hopelessness

B Spiritual distress Joel is expressing distress regarding his religion and spiritual well-being. Joel could be experiencing ineffective coping, but this does not directly relate to his comment. There is nothing in Joel's comment that would lead to the conclusion the patient is having thoughts of harming himself. Joel's comment does not describe hopelessness. Text page: 117

You are conducting an admission interview with Callie, who was raped 2 weeks ago. When you ask Callie about the rape, she becomes very anxious and upset and begins to sob. Your best course of actions would be to: A push Callie gently for more information about the rape because you need to document this in her chart. B acknowledge that the topic of the rape is upsetting to Callie and reassure her that it can be discussed at another time when she feels more comfortable. C use silence as a therapeutic tool and wait until Callie is done sobbing to continue discussing the rape. D reassure Callie that anything she says to you will remain confidential.

B acknowledge that the topic of the rape is upsetting to Callie and reassure her that it can be discussed at another time when she feels more comfortable. The best atmosphere for conducting an assessment is one with minimal anxiety on the patient's part. If a topic causes distress, it is best to abandon the topic at that time. It is important not to pry or push for information that is difficult for the patient to discuss. The use of silence continues to expect the patient to discuss the topic now. Reassurance of confidentiality continues to expect the patient to discuss the topic now. Text page: 117

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

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

When a couple in their early 40s tells the nurse that they have not had sexual relations in more than 5 years, the nurse should initially A mention that a lack of sexual desire is not an uncommon problem. B ask whether the couple finds this troublesome and are seeking help. C ask the couple about any medical conditions they have. D remain noncommittal and allow them to take the lead.

B ask whether the couple finds this troublesome and are seeking help. The nurse should not assume that the couple wishes to change this circumstance; the nurse must ask them if that is the case.

A client who presents no danger to himself or to others is forced to take medication against his will. This situation represents A assault. B battery. C defamation. D invasion of privacy.

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

A client has been diagnosed with gender identity disorder. The nurse can expect that the client will evidence A intense sexual urges focused on an object. B discomfort with biological gender. C self-humiliation during the sexual act. D inability to maintain sexual arousal.

B discomfort with biological gender. Gender identity disorder involves the lack of a match between biological gender and psychological gender anxiety. The client will state that he is a woman who was mistakenly given a man's body.

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

B holds responsibility to family as central. The Eastern traditional world view is sociocentric. Individuals experience their selfhood and their lives as part of an interdependent web of relationships and expectations.

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

B least restrictive alternative doctrine. Least restrictive alternative doctrine is described as using the least drastic means of achieving a specific goal. By doing the actions described you are possibly preventing the more restrictive setting of seclusion and/or restraints. Writ of habeas corpus is a legal term meaning a written order "to free the person." Veracity is one of the five ethical principles or guidelines. Bioethics refers to ethics in a health care setting. Text page: 100

Disorders that involve variations in sexual behaviors are called A pedophilias. B paraphilias. C frotteurism. D sadomasochism.

B paraphilias. The essential features of paraphilias are recurrent and intense sexually arousing fantasies, sexual urges, or behaviors generally involving inanimate objects, the suffering or humiliation of oneself or a partner, or the use of children or other nonconsenting persons.

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

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

You are interviewing Lance, a 31-year-old patient who has been referred to the sexual disorders clinic by his primary care provider. When describing his problem, Lance states, "I can have an orgasm, no problem. It just happens way too soon." Lance is describing: A erectile disorder. B premature ejaculation. C delayed ejaculation. D male hypoactive sexual desire disorder.

B premature ejaculation. In premature ejaculation, a man persistently or recurrently achieves orgasm and ejaculation before he wishes to. Erectile disorder (also called erectile dysfunction and impotence) refers to failure to obtain and maintain an erection sufficient for sexual activity. In delayed ejaculation, a man achieves ejaculation during coitus only with great difficulty. Male hypoactive sexual desire disorder is characterized by a deficiency or absence of sexual fantasies or desire for sexual activity. Text page: 383

The most beneficial nursing intervention directed toward minimizing the discomfort associated with conducting a sexually focused assessment is to A assure the client that the responses will be kept confidential. B provide the client with a rationale for asking the questions. C begin with the most relevant, nonpersonal question. D project a relaxed, causal demeanor when questioning the client.

B provide the client with a rationale for asking the questions. Letting the client know why the questions are being asked increases openness and cooperation.

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

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

Carina, a student nurse on rotation in the emergency department, is assigned to care for Daniel, who was brought in from the local prison with suspected appendicitis. Daniel is in prison for child rape. Carina's niece was recently sexually abused, and Carina feels this type of crime is reprehensible. She begins feeling very upset and disgusted with Daniel because of his crime and doesn't know how she can care for him without letting her feelings show. Carina's best course of action is to: A refuse the assignment because her personal feelings will prevent her from giving good care. B talk with her faculty member or an experienced nurse in the emergency department. C perform the activities of care but not engage in conversation with the patient. D tell Daniel honestly how she feels and let him choose to request a different nurse.

B talk with her faculty member or an experienced nurse in the emergency department. Nurses may experience distress when providing care for someone who engages in what they view as objectionable, or even reprehensible, acts. This is sometimes compounded by knowing someone who was a victim or having been victimized ourselves. Talking with a faculty member, a nurse mentor, or someone at a mental health clinic can be helpful and important and may even result in better personal understanding and coping. Refusing an assignment is not an option. Performing the activities of care but not engaging in conversation does not appropriately or fully care for the patient. Telling the patient how she feels would be unprofessional and inappropriate, and is putting the burden of our own feelings onto the patient. Text page: 395

When assessing and planning treatment for a client who has recently arrived in the United States from China, the nurse should be alert to the possibility that the client's explanatory model for his illness reflects A supernatural causes. B negative forces. C inheritance. D imbalance.

D imbalance. Many Eastern cultures explain illness as a function of imbalance.

You are interviewing Jamie, a 17-year-old female patient. She confides that she has been thinking of ways to kill a female peer who is Jamie's rival for the volleyball team captain position. She asks you if you can keep it a secret. The most appropriate response for you to make is: A "I will keep it a secret, but you and I need to discuss ways to deal with this situation appropriately without committing a crime." B "Yes, I will keep it confidential. We have laws to protect patients' confidentiality." C "Jamie, issues of this kind have to be shared with the treatment team and your parents." D "Jamie, I will have to share this with the treatment team, but we will not share it with your parents."

C "Jamie, issues of this kind have to be shared with the treatment team and your parents." Although adolescent patients request confidentiality, issues of sexual abuse, threats of suicide or homicide, or issues that put the patient at risk for harm must be shared with the treatment team and the parents. A threat of this nature must be discussed with the treatment team and the parents. Confidentiality laws do not protect information that would lead to harm to the patient or others. This information would be shared with both the team and the parents. Text page: 118

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

C "So, ethnicity refers to shared history and heritage, whereas culture refers to sharing the same beliefs and values." Ethnicity is sharing a common history and heritage. Culture comprises the shared beliefs, values, and practices that guide a group's members in patterned ways of thinking and acting. The other options are all incorrect definitions of ethnicity and culture.

You are working in the emergency department when a 26-year-old male patient is brought in suffering from psychosis. The patient is unable to give any coherent history. The patient's best friend is with him and offers to give you information regarding the patient. Which of the following responses is appropriate? A "I'm sorry, but I cannot take any information from you as it would violate confidentiality laws." B "There is no need for that as I will call his primary care provider to obtain the information we need." C "Yes, I will be happy to get any information and history that you can provide." D "Yes, however, we will have to get a release signed from the patient for you to be able to talk with me."

C "Yes, I will be happy to get any information and history that you can provide." The friend is a secondary source of information that will be helpful since the patient is not able to give any history or information at this time. Confidentiality laws do not prohibit obtaining information from a secondary source. The friend can provide information and/or history immediately and may be able to relate events that happened just before coming to the hospital. A release would not be necessary to take information about the patient from a secondary source, and a psychotic patient would not be competent to sign a release. Text page: 117

Which source of healing might be most satisfactory to a client who believes his illness is caused by spiritual forces? A Acupuncture B Dietary change C Cleansings D Herbal medicine

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

A client with paraphilia tendencies tells the nurse that "I'm disgusted with my lifestyle." The nurse most appropriately A assures him that his condition responds well to treatment. B tells him that the first step to managing his behavior is recognizing it as unhealthy. C assesses him for the existence of suicidal ideations. D recommends inpatient behavioral modification therapy.

C assesses him for the existence of suicidal ideations. Such clients may be severely depressed and have suicidal ideations that must be recognized immediately.

A client explains that he is not homosexual but that he prefers to dress in feminine clothing. This is a characteristic of A fetishism. B exhibitionism. C voyeurism. D transvestism.

D transvestism. Transvestism is a paraphilia that involves dressing in the clothing of the opposite sex. REF: 394-395

You find that you feel uncomfortable talking with Lance about his sexual problem. Which of the following actions you could take would be appropriate? A Ask another nurse to take over the interview so you don't project your feelings onto the patient. B Pause the interview and take time to gather your thoughts and do positive self-talk. C Continue the interview using an appropriate professional tone and matter-of-fact approach. D Ask Lance whether he would feel more comfortable speaking with a physician about his problem.

C Continue the interview using an appropriate professional tone and matter-of-fact approach. Remembering your position as a professional and addressing the topics in a tone and manner appropriate of a professional will increase your comfort, along with the patient's. The response in the first option would be confusing to the patient and does not address your feelings or work to resolve them. Pausing the interview would not be appropriate because self-assessment is best done before patient interaction. Asking the patient whether he would feel more comfortable speaking with a physician projects your feelings of being uncomfortable onto the patient and does not carry out your professional role and responsibility. Text page: 385

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

C Lyla, a nurse on the cardiac unit, gives report to Chloe, the nurse on the step-down unit, regarding the patient Lyla, who will be transferring, while they are walking in the hospital hallway. Discussing a patient's information in public places where it may be overheard is a violation of a patient's confidentiality. The other options describe appropriate interactions for patient continuity of care and support of the treatment plan by the health care team. Text page: 105

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

C Nothing may be disclosed that would have been kept confidential before death. Confidentiality extends to death and beyond. Nurses should never disclose information after the death of a client that they would have kept confidential while the client was alive.

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

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

The mental status examination aids in the collection of what type of data? A Covert B Physical C Objective D Subjective

C Objective The mental status exam mostly aids in the collection of objective data. REF:120-121

Which right of the client has been violated if he is medicated without being asked for his permission? A Right to dignity and respect B Right to treatment C Right to informed consent D Right to refuse treatment

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

Which of the following is true of transvestic disorder? A Most people with this disorder are homosexual. B Only men are diagnosed with transvestic disorder. C Sexual orientation has no bearing on transvestic disorder. D Transvestic behavior develops in early to middle adulthood.

C Sexual orientation has no bearing on transvestic disorder. Unlike in gender dysphorias, in transvestic disorder there are no sexual orientation issues, and people with transvestic disorder do not desire a sex change. Transvestites are usually heterosexual. Although more common in men, women are also diagnosed with transvestic disorder. Transvestic disorder usually develops early in life. Text page: 393-394

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

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

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

C appeasement of the spirits. Appeasement of spirits might be a viable outcome criterion if the client believes the illness was caused by angry spirits. In each of the other options useful outcomes would be decreased somatic symptoms, reinstatement of energy balance, and decreased anxiety.

A nurse is about to interview a client whose glasses and hearing aid were placed in safe-keeping when she was admitted. Before beginning the interview, the nursing intervention that will best facilitate data collection is to A ask the client if she needs her glasses and hearing aid. B give the client her glasses and hearing aid. C assist the client in putting on glasses and hearing aid. D explain the importance of wearing her hearing aid and glasses.

C assist the client in putting on glasses and hearing aid. A client whose hearing or sight is impaired may have difficulty providing information if these items have been removed from his or her possession. Assisting the client in wearing these assistive devices is the best initial intervention. REF: Page 118-119

When members of a group are introduced to the culture's worldview, beliefs, values, and practices, it is called A acculturation. B ethnocentrism. C enculturation. D cultural encounters

C enculturation. Members of a group are introduced to the culture's worldview, beliefs, values, and practices in a process called enculturation. Ethnocentrism is the universal tendency of humans to think that their way of thinking and behaving is the only correct and natural way. Acculturation is learning the beliefs, values, and practices of a new cultural setting, which sometimes takes several generations. Cultural encounters occur when members of varying cultures meet and interact.

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

C false imprisonment. False imprisonment is the arbitrary holding of a client against his or her will. When seclusion is ordered, it is not invoked arbitrarily, but after other less restrictive measures have failed. If the client is secluded without the medical order, the measure cannot be proven as instituted for medically sound reasons. REF: Page 107-108 (Table 6-3)

If a nurse is charged with leaving a suicidal client unattended, it is being suggested that the nurse's behavior has violated the ethical principle of A autonomy. B veracity. C fidelity. D justice.

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

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

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

Clients of another culture are at greatest risk for misdiagnosis of a psychiatric problem because of A biased assessment tools. B insensitive practitioners. C insensitive interviewing techniques. D lack of the availability of cultural translators.

C insensitive interviewing techniques. Inaccurate information or insufficient information may be obtained if the interviewer is not culturally sensitive. Only when assessment data are accurate can effective treatment be planned.

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

C maintaining currency in state laws affecting nursing practice. Each nurse's practice is governed by the Nurse Practice Act of the state in which the nurse practices. The nurse should always be aware of its provisions.

The client reveals to the nurse that, "I'm turned on by little girls, not adult women." The nurse can assess this condition as A exhibitionism. B hedonism. C pedophilia. D voyeurism.

C pedophilia. Pedophilia involves sexual fantasies, urges, or behaviors with a child aged 13 years or younger.

An older client who has been prescribed antipsychotic medication for several years tells the nurse that he is experiencing sexual dysfunction. The nurse should suspect that the client's sexual disorder may be caused by A disturbed interpersonal relationships. B his psychiatric disorder. C side effects of the medications. D age.

C side effects of the medications. Schizophrenia is not necessarily associated with sexual dysfunction or deviant sexual behavior, but the symptoms of schizophrenia and even the treatment with neuroleptic medications may make the client vulnerable to disturbances in sexual functioning and often cause the client to be childlike and passive in relationships.

Hormone therapy for the purpose of surgical gender reassignment is initiated when the client has A successful demonstrated a genuine intent to change genders. B taken on the dress and manners of the preferred gender. C successfully lived the crossgender role for 2 consecutive years. D taken all legal steps to change name and legal status.

C successfully lived the crossgender role for 2 consecutive years. After 2 years of living as a member of the desired gender, if the client still wishes to proceed with gender reassignment, hormone therapy can be initiated.

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

C the defining data and the nursing diagnosis. When choosing nursing interventions from the Nursing Interventions Classification or some other source, the nurse selects interventions that fit the nursing diagnosis (e.g., risk for suicide) and that match the defining data. REF:126-127

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

C voluntarily. Voluntary admission occurs when the client is willing to be admitted and agrees to comply with hospital and unit rules. REF: Page 100-101

Which response to a patient's question of why you need to conduct an assessment interview best explains its purpose? A "I need to find out more about you and the way you think in order to best help you." B "The assessment interview lets you have an opportunity to express your feelings." C "You are able to tell me in detail about your past so that we can determine why you are experiencing mental health alterations." D "We will be able to form a relationship together where we can discuss the current problems and come up with goals and a plan for treatment."

D "We will be able to form a relationship together where we can discuss the current problems and come up with goals and a plan for treatment." Some of the purposes of the assessment interview are to establish rapport, learn more about the presenting issues, and form mutual goals and a plan for treatment. The other options do not appropriately explain the assessment purpose. Text page: 119

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

D "What role does religion play in your life?" Asking the client to define the role of religion in their life allows for discussion related to the other topics. REF: Page 121-122

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

D are concerned with being part of a harmonious community. Clients with an indigenous worldview are interested in connectedness and being in harmony with others. They have little interest in personal goals and autonomy.

Deviation from cultural expectations is considered by members of the cultural group as a demonstration of A hostility. B lack of self-will. C variation from tradition. D illness.

D illness. Deviation from cultural expectations is considered by others in the culture to be a problem and is frequently defined by the cultural group as "illness."

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

D "What you are saying is actually considered cultural imposition, which is imposing our own culture onto someone from a different culture." E "Mr. Tran's ability to speak and understand English is very limited. He needs to have an interpreter to make sure he can make his needs and feelings known." Cultural imposition is imposing our own cultural norms onto those from another cultural group. By obtaining an interpreter for Mr. Tran, the nurse is promoting culturally competent care, ensuring the patient can communicate his feelings and needs thoroughly to the staff. Patients do have a right to an interpreter, but stating that Mike is right is not promoting culturally competent care and is instead confirming his opinion. Asking family members to convince the patient to speak English is not promoting culturally competent care and also undermines the trust between nurse and patient. Instead of encouraging the patient to speak English an interpreter should be obtained for the patient.

Which criterion is NOT essential when the nurse plans nursing interventions designed to meet a specific goal? A Safe B Evidence based C Individualized D Economical

D Economical Although expense should be considered, interventions are chosen based on the other options and not on their economic value. REF:124-125

Which activity is NOT considered a purpose of the initial psychiatric assessment? A Obtaining understanding of the current problem B Identifying treatment goals C Formulating a plan of care D Evaluating the results of intervention

D Evaluating the results of intervention At an initial assessment, no interventions would have taken place; hence evaluation is not a purpose of the initial contact.

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

D Imbalanced nutrition: less than body requirements related to poor self-concept as evidenced by reporting "I'm not worthy of eating" This diagnosis contains all the required components: problem statement, the etiology, and supporting data. REF: Page 123

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

D Mail is a form of social interaction and so receiving mail is a client's civil right. The client's civil rights are intact, despite hospitalization. The right to communicate with those outside the hospital is ensured.

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

D Nursing Outcomes Classification (NOC). The Nursing Outcomes Classification is a publication used as a resource across the United States. REF:124-125

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

D Report the incident to the client's therapist and document. The Tarasoff ruling makes it necessary for nurses to report client statements that imply the client may harm another person or persons. The nurse reports to the treatment team, and the mandated reporter (usually the professional leader of the team) is responsible for notifying the person against whom the threat was made. REF: Page 106-107

Which healing practice is least used in the Western health system of healing practices? A Antibiotic medication B Surgery C Targeted cellular destruction D Restoring lost balance or harmony

D Restoring lost balance or harmony The best treatment perspectives of various cultures include regaining lost balance and harmony. This perspective is not used in Western culture.

Lance asks you what medication is usually used for premature ejaculation. You educate him regarding a class of medications that are used for treatment but have to be monitored for the possibility of dosage reduction or change related to the possibility of causing sexual side effects. Which of the following is the class of medications you are educating Lance about? A MAO inhibitors B Tricyclic antidepressants C Atypical antipsychotics D SSRI antidepressants

D SSRI antidepressants Treatments include antidepressants in the selective serotonin reuptake inhibitor (SSRI) category. Conversely, pharmacotherapy may cause erectile dysfunction, and medications may need to be evaluated for change or dose reduction. The other options are not used for premature ejaculation. Text page: 397

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

D The client is a danger to self or others or unable to meet basic needs. Involuntary admission implies that the client did not consent to the admission. The usual reasons for admitting a client over his or her objection is if the client presents a clear danger to self or others or is unable to meet even basic needs independently. REF: Page 100-101