Unit III Mental Health Test Bank (Correct Answer)

14.23. A nurse is caring for four clients. Which of the following clients should the nurse identify as likely to experience difficulty in being assertive? Select all that apply.

ANSWER: A, B, C A. A 20-year-old woman who is completing college homework assignments for several peers. B. A 69-year-old widow who is socially isolated C. A 17-year-old boy with conduct disorder RATIONALE: The woman who is taking on the work of others in addition to her own may be having difficulty assertively saying no; the widow who is socially isolated may lack the necessary skills to communicate her needs; and the boy with a conduct disorder is likely to demonstrate aggressive behaviors. The business executive and an individual diagnosed with narcissistic personality disorder are the least likely to have difficulty being assertive.

15.16. A 47-year-old mother of two has recently undergone a radical mastectomy. She refuses to see anyone and remains isolated and withdrawn. Which of the following may be relevant nursing diagnoses for this client? Select all that apply.

ANSWER: A, B, C A. Disturbed body image B. Situational low self-esteem C. Ineffective coping RATIONALE: The mastectomy is likely to disturb the clients body image. She is ineffectively coping by withdrawing. She may be experiencing negative feelings about herself related to her altered body image, which would result in low self-esteem. None of the symptoms presented indicate a problem with either altered thought or altered sensory perception.

15.15. A nurse is caring for a client who has recently undergone a radical prostatectomy. Which of the following should the nurse recognize as objective symptoms of low self-esteem? Select all that apply.

ANSWER: A, B, C, E A. Withdrawal from activities B. A decrease in self-care behaviors C. Poor eye contact E. Poor posture RATIONALE: Withdrawal from activities, a decrease in self-care behaviors, eye contact, and poor posture are all common objective manifestations of low self-esteem. A report of pain should be evaluated as a physical issue before being attributed solely to low self esteem.

10.21. Which of the following observed client behaviors would lead a nurse to evaluate a member as assuming a maintenance group role? Select all that apply.

ANSWER: A, B, D A. A client decreases conflict within the group by encouraging compromise. B. A client offers recognition and acceptance of others. D. A client listens attentively to group interaction. RATIONALE: The nurse should identify clients who decrease conflict within the group, offer recognition and acceptance of others, and listen attentively to group interaction as assuming a maintenance group role. There are member roles within each group. Maintenance roles include the compromiser, the encourager, the follower, the gatekeeper, and the harmonizer.

11.10. An instructor is teaching about differentiated parent and adult child relationships. Students are instructed to give an example of a well-differentiated parent and adult child relationship. Which student example meets the instructor requirement?

ANSWER: A. An adult child considers, but is not governed by, the advice of his or her parents. RATIONALE: The correct student example of a well-differentiated parent and adult child relationship is when an adult child considers, but is not governed by, the advice of his or her parent. The adult child should be differentiated enough not to be threatened by parental advice and should be able to consider the parental advice without feeling the advice must be followed.

15.7. Which is an appropriate initial nursing intervention for a client with chronic low self-esteem?

ANSWER: A. Assessing the content of negative self-talk RATIONALE: Self-negating verbalizations and internal self-talk undermine self-esteem. Assessing and then intervening to limit or eliminate these negative communications will help improve self-esteem.

10.2. During a therapeutic group, two clients engage in an angry verbal exchange. The nurse leader interrupts the exchange and excuses both of the clients from the group. The nurse has demonstrated which leadership style?

ANSWER: A. Autocratic RATIONALE: The nurse who excuses clients from the group has demonstrated an autocratic leadership style. An autocratic leadership style may be useful in certain situations that require structure and limit-setting. Democratic leaders focus on the members of the group and group-selected goals. Laissez-faire leaders provide no direction to group members.

14.2. Two clients are roommates on an inpatient psychiatric unit. At breakfast, client A, who had been missing her gold locket, notices client B wearing it. Which should a nurse recognize as a nonassertive or passive behavioral response from client A?

ANSWER: A. Client A ignores the situation. RATIONALE: By ignoring the situation, client A avoids conflict, denies her feelings, and does not assertively resolve the problem. This is an example of nonassertive behavior.

14.10. Two clients get into a heated argument regarding TV program selections. The nurse turns off the TV and asks the clients to go to their rooms to cool off, after which they will discuss and attempt to resolve the problem. The nurses action is promoting which assertive technique?

ANSWER: A. Defusing RATIONALE: Defusing is a technique that delays further discussion with an angry individual until a calm demeanor has been achieved. In the situation presented, the nurse is allowing the clients to calm down prior to addressing their issues.

10.4. During a community meeting, a nurse encourages clients to present unit problems and discuss possible solutions. Which type of leadership style is the nurse demonstrating?

ANSWER: A. Democratic RATIONALE: The nurse who encourages clients to present problems and discuss solutions is demonstrating a democratic leadership style. Democratic leaders share information with group members and promote decision making by the members of the group. The leader provides guidance and expertise as needed.

12.5. To promote self-reliance, how should a psychiatric nurse best conduct medication administration?

ANSWER: A. Encourage clients to request their medications at the appropriate times. The psychiatric nurse promoting self-reliance would encourage clients to request their medications at the appropriate times. Nurses are responsible for the management of medication administration on inpatient psychiatric units; however, nurses must work with clients to foster independence and provide experiences that would foster increased self-esteem.

15.9. A 40-year-old female client has never experienced an intimate relationship. A nursing student tells an instructor that this client remains in Eriksons developmental stage of intimacy versus isolation. What is the instructors most appropriate reply?

ANSWER: A. Eriksons stages of development are assessed by chronological age, not task achievement. This client is in the generativity versus stagnation stage, which occurs from 30 to 65 years of age. RATIONALE: Eriksons stages of development are assessed by chronological age, not task achievement. This client is in Eriksons stage of generativity versus stagnation because she is 40 years old. The student has failed to recognize that even though the client did not successfully achieve the intimacy task of the intimacy versus isolation stage, the client must now be assessed at the age-appropriate developmental stage of generativity versus stagnation.

12.3. A newly admitted client asks, Why do we need a unit schedule? I'm not going to these groups. I'm here to get some rest. Which is the most appropriate nursing reply?

ANSWER: A. Group therapy provides the opportunity to learn and practice new coping skills. RATIONALE: The nurse should explain to the client that the purpose of group therapy is to learn and practice new coping skills. A basic assumption of milieu therapy is that every interaction, including group therapy, is an opportunity for therapeutic intervention.

10.8. During a group discussion, members freely interact with each other. Which member statement is an example of Yaloms curative group factor of imparting information?

ANSWER: A. I found a Web site explaining the different types of brain tumors and their treatment. RATIONALE: Yaloms curative group factor of imparting information involves sharing knowledge gained through formal instruction as well as by advice and suggestions given by other group members.

14.21. Which of the following are behavioral components of assertive communication?

ANSWER: A. Listening RATIONALE: One part of assertiveness communication and behavior is to listen and take time to understand what is being said before giving a response.

15.3. A nurse is running a group on self-esteem. A client asks, Where does self-esteem come from? Which is the most appropriate nursing reply?

ANSWER: A. Many factors, over the life span, influence development and maintenance of self-esteem. RATIONALE: Self-esteem refers to the degree of regard or respect that individuals have for themselves and is a measure of worth that they place on their abilities and judgments. Many factors influence the development of self-esteem over a persons life span.

15.14. A client has continual problematic relationships and rejects others before possibly being rejected. The client states, I am afraid of failing in my job responsibilities. Which correctly written nursing diagnosis should be prioritized for this client?

ANSWER: A. Poor self-esteem R/T negative self-image AEB fear of failure RATIONALE: Individuals with low self-esteem perceive themselves to be incompetent, unlovable, insecure, and unworthy. A correctly written actual nursing diagnosis must have a related to (R/T) and an evidenced by (AEB) statement. A risk for nursing diagnosis does not contain an AEB statement because the problem has not yet occurred.

11.6. A clinic nurse is caring for a 40-year-old client who lives with his parents. The clients mother continues to do the clients laundry and provides spending money. Based on this situation, which family dynamic does the nurse recognize?

ANSWER: A. Taking over RATIONALE: Taking over occurs when a family member fails to allow another member to develop a sense of responsibility and self-worth. By doing the clients laundry and managing finances, the mother is fostering the clients dependence.

10.10. During an inpatient educational group, a client shouts out, This information is worthless. Nothing you have said can help me. These statements indicate to the nurse leader that the client is assuming which group role?

ANSWER: A. The group role of aggressor RATIONALE: The nurse should identify that the client is assuming the group role of the aggressor. The aggressor expresses negativism and hostility toward others in the group or to the group leader and may use sarcasm in an effort to degrade the status of others.

11.2. In defiance of parental wishes, a Japanese teenager succumbs to peer pressure and gets a tattoo. According to Bowens family systems theory, how should the community health nurse interpret the teenagers action?

ANSWER: A. The teenager is attempting to differentiate self. RATIONALE: The teenager is taking on some of the cultural values of peers and is beginning to develop a unique identity. This process is called differentiation and is a normal task of adolescence.

10.18. A 10-week, prenuptial counseling group composed of five couples is terminating. At the last group meeting, a nurse notices that the two most faithful and participative couples are absent. When considering concepts of group development, what might explain this behavior?

ANSWER: A. They are experiencing problems with termination, leading to feelings of abandonment. RATIONALE: The nurse should determine that the clients absence from the final group meeting may indicate that they are experiencing problems with termination. The termination phase of group development may elicit feelings of abandonment and anger. Successful termination may help members develop skills to cope with future unrelated losses.

11.15. A couple is in counseling related to their dysfunctional relationship. Their daughter has recently made a suicide gesture. The nurse should recognize that this might be an example of which family system concept?

ANSWER: A. Triangulation RATIONALE: Triangulation occurs when a relationship between two people is dysfunctional. A third person is brought into the relationship to help stabilize it. The couple is triangulating with their daughter. The threatened daughter draws attention from her parents interpersonal conflicts by her own dysfunctional behavior.

14.6. During an assertiveness training group, a nurse suggests using I statements. The group questions the usefulness of this communication technique. Which explanation by the nurse is most appropriate?

ANSWER: A. When I statements are used, opinions are communicated without blaming others. RATIONALE: I statements clearly state ones feelings and needs without blaming or demeaning others.

14.15. One nurse confronts another and says, You are always so talkative in the meetings. I don't know why you cant stay quiet sometimes. Which reply by the other nurse reflects the technique of clouding/fogging?

ANSWER: A. You're right. I do speak up a lot. RATIONALE: This response reflects the use of clouding/fogging. When clouding/fogging is used it concurs with the critics argument without becoming defensive and without agreeing to change.

18.3. A third-grader feigns illness in order to avoid doing homework. The teacher recommends an educational program that uses a token economy. How should a school nurse explain a token economy to this child's parent?

ANSWER: A. Your child will receive green tokens for completing homework that can be cashed in for desired rewards. RATIONALE: In a token economy, tokens are a form of contingency contracting in that tokens immediately reinforce appropriate behavior (completed homework) and are exchanged later for a desired reward.

10.22. Which of the following behavioral skills should a nurse implement when leading a group that is functioning in the orientation phase of group development? Select all that apply.

ANSWER: B, C, D B. Ensuring that rules established by the group do not interfere with goal fulfillment C. Working with group members to establish rules that will govern the group D. Emphasizing the need for and importance of confidentiality within the group RATIONALE: During the orientation phase of group development, the nurse leader should work together with members to establish rules that will effectively govern the group. The leader should ensure that group rules do not interfere with goal fulfillment and establish the need for and importance of confidentiality within the group. Members need to establish trust and cohesion to move into the working phase of group development.

12.11. A nurse attends an interdisciplinary team meeting on an inpatient unit. Which of the following individuals are typically included as members of the interdisciplinary treatment team in psychiatry? Select all that apply.

ANSWER: B, C, D, E B. Occupational therapist C. Recreational therapist D. Social worker E. Mental health technician RATIONALE: The typical interdisciplinary treatment team in a psychiatric inpatient setting consists of a psychiatrist, psychiatric nurse, psychiatric social worker, music therapist, dietician, psychologist, occupational therapist, recreational therapist, art therapist, mental health technician, and chaplain. Other disciplines may be included on the basis of resources available in a particular hospital setting and individual patient needs.

12.12. Which of the following are accurate descriptors of a therapeutic community? Select all that apply.

ANSWER: B, E B. Unit responsibilities are assigned according to client capabilities. E. A democratic form of government exists. RATIONALE: In a therapeutic community the unit responsibilities are assigned according to client capability, and a democratic form of government exists. Therapeutic communities are structured and provide therapeutic interventions that focus on communication and relationship-development skills.

14.4. A client continually waits more than an hour before being seen at the mental health clinic. The client approaches the nurse and states, When I have to wait for more than an hour to be seen, I feel like my time is not important. The nurse recognizes this as what type of behavior?

ANSWER: B. Assertive behavior RATIONALE: This response is assertive. The client is openly expressing feelings and attempting to correct a stressful situation.

14.1. During a psychoeducational group on assertiveness training, a client asks, Why do we need to learn about this stuff? Which is the most appropriate nursing reply?

ANSWER: B. Being assertive is the ability to stand up for yourself while respecting the rights of others. RATIONALE: Assertiveness training assists people to maintain their own self-respect and meet their needs while respecting the rights of others.

18.4. A client is diagnosed with an anxiety disorder. The nurse counselor recommends intervention with the behavioral technique of reciprocal inhibition. The client asks, Whats that? Which is the most appropriate nursing reply?

ANSWER: B. By introducing an adaptive behavior that is mutually exclusive to your maladaptive behavior, we will expect subsequent behavior to improve. RATIONALE: Reciprocal inhibition decreases or eliminates an undesired behavior by introducing a more adaptive behavior that is incompatible with the undesired behavior.

15.2. A client shows a nurse a piece of artwork that took 3 days to create. How will this achievement improve the clients self-esteem?

ANSWER: B. By providing an expression of feelings and a sense of competence and pride RATIONALE: Creating the artwork provides expression of feelings and a sense of competence and pride. This will most likely have a positive effect on the clients self-esteem.

15.6. On the basis of Eriksons theory, how should a nurse encourage a 40-year-old client to improve his or her self-esteem?

ANSWER: B. Encourage the client to volunteer at a school, reading to underprivileged children. RATIONALE: Making meaningful contributions to others is a way to meet the developmental task of the generativity versus stagnation (30 to 65 years) stage of Eriksons developmental theory. This action would promote a 40-year-old clients self-esteem.

11.17. A nursing instructor is teaching about the importance of healthy family-member expectations for newly blended families. Which student statement indicates a need for further instruction?

ANSWER: B. Healthy family-member expectations should be conforming. RATIONALE: Conforming is a behavior that interferes with adaptive functioning in terms of family member expectations. This student statement indicates a need for further instruction. Realism, flexibility, and individuality are all characteristics of healthy family-member expectations.

10.12. During a group session, which client statement demonstrates that the group has progressed to the middle, or working, phase of group development?

ANSWER: B. I think Joe's Antabuse suggestion is a good one and might work for me. RATIONALE: The nurse should determine that group members have progressed to the working phase of group development when members begin to look to each other instead of to the leader for guidance. Group members in the working phase begin to accept criticism from each other and then use it constructively to foster change.

10.7. A man diagnosed with alcohol dependence experiences his first relapse. During his AA meeting, another group member states, I relapsed three times, but now have been sober for 15 years. Which of Yaloms curative group factors does this illustrate?

ANSWER: B. Instillation of hope RATIONALE: This scenario is an example of the curative group factor of instillation of hope. This occurs when members observe the progress of others in the group with similar problems and begin to believe that personal problems can also be resolved.

18.2. An adolescent comes from a dysfunctional family where physical and verbal abuse prevails. At school this adolescent bullies and fights with classmates. According to principles of behavior therapy, what is the probable source of this behavior?

ANSWER: B. Modeling RATIONALE: Modeling is the learning of new behaviors by imitating the behaviors of others. This adolescent, witnessing physical and verbal abuse in the home, models this behavior in school.

14.11. An emergency department nurse, who has worked 10 straight days, is pulled to the psychiatric unit. Which represents a passive-aggressive statement by the emergency department nurse?

ANSWER: B. Okay. I'll do it, then purposefully leaves paperwork undone when leaving the unit at 11 p.m. RATIONALE: This response is passive-aggressive. The staff nurses anger is expressed indirectly.

18.9. Parents of a 3-year-old have noticed an improvement in behavior because of using a time out behavioral approach. What aspect of time out therapy may be responsible for this child's improved behavior?

ANSWER: B. Positive reinforcement is removed. RATIONALE: In a time out, the positive reinforcement of attention is removed from the child during inappropriate behavior.

14.16. A teenager gets a C in algebra. The mother angrily states, All you ever do is listen to music and text your friends. The teenager replies, What is it that you're really upset about, mom? Which response pattern is the teenager expressing?

ANSWER: B. Shifting from content to process RATIONALE: This response reflects the use of shifting from content to process. The teenager is changing the focus of the communication from discussing the topic at hand to analyzing what is actually going on in the interaction.

12.4. A client diagnosed with schizophrenia functions well and is bright, spontaneous, and interactive during hospitalization but then decompensates after discharge. What does the milieu provide that may be missing in the home environment?

ANSWER: B. Structured programming RATIONALE: The milieu, or therapeutic community, provides the client with structured programming that may be missing in the home environment. The therapeutic community provides a structured schedule of activities in which interpersonal interaction and communication with others are emphasized. In the milieu, time is also devoted to personal problems and focus groups.

10.15. The nurse should utilize which group function to help an extremely withdrawn, paranoid client increase feelings of security?

ANSWER: B. Support RATIONALE: The nurse should identify that the group function of support would help an extremely withdrawn, paranoid client increase feelings of security. Support assists group members in gaining a feeling of security from group involvement.

11.13. During family counseling, a husband tells his wife to spend more time with the family, and she responds by stating, "Okay, I'll turn in my resignation tomorrow." The husband replies, "I knew it! You've always been a quitter!" How should the nurse interpret the husbands statement?

ANSWER: B. The husband is expressing double-bind communication. RATIONALE: Double-bind communication sets up no-win situations. The husband has created a situation in which no matter what the wife does, she is wrong.

10.1. During a therapeutic group, a client talks about personal accomplishments in an effort to gain attention. Which group role, assumed by this client, should the nurse identify?

ANSWER: B. The individual role of recognition seeker RATIONALE: The nurse should evaluate that the client is assuming the individual role of the recognition seeker. Other individual roles include the aggressor, the blocker, the dominator, the help seeker, the monopolizer, and the seducer.

12.7. What is the best rationale for including the clients family in therapy within the inpatient milieu?

ANSWER: B. To facilitate discharge from the hospital RATIONALE: The nurse should include the clients family in therapy within the inpatient milieu to facilitate discharge from the hospital. Family members are invited to participate in some therapy groups and to share meals with the client in the communal dining room. Family involvement may also serve to prevent the client from becoming too dependent on the therapeutic environment.

11.9. After hearing parents discuss divorce, a 5-year-old develops behavioral problems. Upon dealing with the child's behavioral issues, the marital relationship conflict decreases. The pediatric clinic nurse should recognize that this is an example of which family system concept?

ANSWER: B. Triangulation RATIONALE: Triangulation occurs when a relationship between two people is dysfunctional so a third person is brought into the relationship to help stabilize it. The son and his behavioral problems redirect the focus from the couples marital problems.

10.5. Which situation should a nurse identify as an example of an autocratic leadership style?

ANSWER: B. Without faculty input, the dean mandates that all course content be delivered via the Internet. RATIONALE: The nurse should identify that mandating decisions without consulting the group is considered an autocratic leadership style. Autocratic leadership increases productivity but often reduces morale and motivation due to lack of member input and creativity.

10.19. An experienced psychiatric registered nurse has taken a new position leading groups in a day treatment program. Without further education, which group is this nurse most qualified to lead?

ANSWER: C. A parenting group RATIONALE: A psychiatric registered nurse is qualified to lead a parenting group. A parenting group can be classified as either a teaching group or therapeutic group. Psychodrama, psychotherapy, and family therapy are forms of group therapy that must be facilitated by qualified leaders who generally have advanced degrees in psychology, social work, nursing, or medicine.

12.8. How does a democratic form of self-government in the milieu contribute to client therapy?

ANSWER: C. By setting community expectations wherein all clients are treated on an equal basis RATIONALE: A democratic form of self-government in the milieu contributes to client therapy by setting the expectation that all clients should be treated on an equal basis. Clients participate in the decision-making and problem-solving aspects that affect treatment setting. The norms, rules, and behavioral limits are established by the staff and clients. All individuals have input.

10.16. When planning group therapy, a nurse should identify which configuration as most optimal for a therapeutic group?

ANSWER: C. Closed membership; circle of chairs; group size of 5 to 10 members RATIONALE: The nurse should identify that the most optimal conditions for a therapeutic group are when the membership is closed and the group size is between 5 and 10 members who are arranged in a circle of chairs. The focus of therapeutic groups is on relationships within the group and the interactions among group members.

11.18. A client is angry because her husband has forgotten their anniversary. The following week, the client is still unwilling to discuss this with her husband because she is afraid she will lose control. How should the nurse interpret this clients means of coping with anger?

ANSWER: C. Coping by avoiding RATIONALE: When coping by avoidance, differences are never acknowledged openly. The individual who disagrees avoids discussing it for fear that the other person will withdraw love or approval or become angry in response to the disagreement. Avoidance also occurs when an individual fears loss of control of his or her temper.

14.9. A nurse should assign which nursing diagnosis to a client needing assistance with assertiveness?

ANSWER: C. Defensive coping RATIONALE: Defensive coping reflects a self-protective pattern that defends against underlying perceived threats to positive self-regard. Clients who are utilizing defensive coping lack assertiveness skills.

12.1. An angry client on an inpatient unit approaches a nurse, stating, Someone took my lunch! People need to respect others, and you need to do something about this now! The nurses response should be guided by which basic assumption of milieu therapy?

ANSWER: C. Every interaction is an opportunity for therapeutic intervention. RATIONALE: The nurses response should be guided by the basic assumption that every interaction is an opportunity for therapeutic intervention. The nurse can utilize milieu therapy to effect behavioral change and improve psychological health and functioning.

11.3. A home health nurse is visiting an Asian family. A married couple, their three children, and the maternal grandparents all live in the home. How should the nurse interpret the presence of the grandparents in the home?

ANSWER: C. Extended family living arrangements are common in some cultures. RATIONALE: The Asian culture highly respects the elderly. Having the grandparents living in the home is not uncommon in this culture.

10.9. Prayer group members at a local Baptist church are meeting with a poor, homeless family they are supporting. Which member statement is an example of Yaloms curative group factor of altruism?

ANSWER: C. I can give you all of my baby clothes for your little one. RATIONALE: Yaloms curative group factor of altruism occurs when group members provide assistance and support to each other, creating a positive self-image and promoting self-growth. Individuals increase self-esteem through mutual caring and concern.

14.7. While trying to control aggressive behavior, a client asks an assertiveness training nurse to give an example of an I statement. Which of the following statements is the best example of this assertive communication technique?

ANSWER: C. I feel angry when you come home late without calling. RATIONALE: This response clearly states feelings about a situation without blaming another.

10.20. A nursing instructor is teaching about psychodrama, a specialized type of therapeutic group. Which student statement indicates that further teaching is necessary?

ANSWER: C. In psychodrama, the client observes actor interactions from the audience. RATIONALE: The nurse should educate the student that in psychodrama the client plays the role of himself or herself in a life-situation scenario and is called the protagonist. During psychodrama, the client does not observe interactions from the audience. Other group members perform the role of the audience and discuss the situation they have observed, offer feedback, and express their feelings. Leaders of psychodrama must have specialized training to become a psychodramatist.

15.5. The nurse is working with a 15-year-old client suffering from low self-esteem. According to Eriksons psychosocial developmental theory, which factor has most probably influenced this clients self-esteem?

ANSWER: C. Inconsistent, overly harsh, or absent parental discipline RATIONALE: When there is inconsistent, overly harsh, or absent discipline in the home, it is difficult for a teenager to develop the independent sense of self needed to achieve a positive self-esteem.

14.17. The dean of nursing criticizes a faculty member about views on academic freedom. The faculty member states, Are you upset because I believe in academic freedom or because you don't? The faculty member is using which technique to promote assertive behavior?

ANSWER: C. Inquiring assertively RATIONALE: This response reflects the use of inquiring assertively. Inquiring assertively is an attempt to seek additional information about critical statements.

15.8. A 30-year-old client diagnosed with depression has been exclusively cared for and financially subsidized by his mother since age 17. According to Eriksons theory, the nurse recognizes that the client has been unsuccessful in meeting which developmental task?

ANSWER: C. Intimacy RATIONALE: The clients relationship with his mother has contributed to failing completion of the developmental task of intimacy in Eriksons stage of intimacy versus isolation (20 to 30 years). This has resulted in behaviors such as withdrawal, social isolation, aloneness, and the inability to form lasting relationships, leading to his diagnosis of depression.

11.16. An adolescent, his mother, and his soon-to-be stepfather have been in counseling with the nurse. Which statement by the nurse fosters positive relationships within this new family structure?

ANSWER: C. Keeping the lines of communication open between everyone in the family is important in establishing healthy relationships. RATIONALE: Open lines of communication are needed for newly forming families to begin their relationship together and establish a new family structure.

11.12. During family counseling a child states, I just want to surf like other kids. Mom says it's okay, but Dad says I'm too young. The mother allows surfing when the father is absent. In the structural model of family therapy, what family interactional pattern should the nurse recognize?

ANSWER: C. Mother-child subsystem RATIONALE: In this situation the mother and child have formed a subsystem in which they have aligned themselves against the father.

11.1. A fatherless, 11-year-old African American girl lives with her grandmother after the death of her mother. Her older stepbrother is very involved in her life. How should the community health nurse view this family constellation, and why?

ANSWER: C. Normal; cultural variations exist in the family life cycle. RATIONALE: The nurse should be aware that cultural differences and specific events may lead to variety in family constellations. This is normal.

14.20. A nurse has identified the following nursing diagnosis: ineffective communication R/T lack of assertiveness skills AEB inability to state needs. Which statement encourages the client to acknowledge the priority of this problem?

ANSWER: C. On a scale of 1 to 10, rank the importance of being assertive. RATIONALE: This nursing statement encourages the client to objectively evaluate the priority of being assertive. It is important in patient-centered care for the client to prioritize his or her goals for treatment.

15.1. A nurse is working in a nursing home. How best can this nurse foster self-esteem in the residents of this facility?

ANSWER: C. Providing a sense of mastery over their environment by giving choices when appropriate RATIONALE: A sense of having some power and control over ones life enhances self-esteem.

15.12. A father tells his 5-year-old, Son, today instead of picking flowers in the outfield, let's try to catch a ball. The child subsequently pays attention and catches a ball. Which principle of building self-esteem has the father implemented?

ANSWER: C. Realistic goals RATIONALE: Low self-esteem can be the result of not being able to achieve established goals. The father has set for the child a realistic goal that the child accomplished. This should promote self-esteem.

11.5. In a family that is in the life cycle stage called The Family with Adolescents, which changes must occur for the family to proceed developmentally?

ANSWER: C. Redefining the level of dependence so that adolescents are provided with greater autonomy RATIONALE: Stage IV of the family life cycle is described as The Family with Adolescents. The task of this stage is to redefine the level of dependence so that adolescents are provided with greater autonomy while parents remain responsive to teenagers dependency needs.

14.19. A nursing supervisor is scheduling holiday hours. When the supervisor tells the staff nurse that she needs to work Christmas day, the staff nurse calmly states, I worked last Christmas and will not work this Christmas. When the supervisor says But I need you to work, the nurse repeats I worked last Christmas and will not work this Christmas. This is an example of which assertive behavior technique?

ANSWER: C. Responding as a broken record RATIONALE: Responding as a broken record is an assertive behavior technique that consists of persistently repeating in a calm voice what is wanted.

15.13. A nursing instructor is teaching about self-concept. Which student statement indicates a need for further instruction?

ANSWER: C. Self-concept is the degree of regard that individuals have for themselves. RATIONALE: Self-esteem, not self-concept, is the degree of regard that individuals have for themselves. This student statement indicates a need for further teaching.

18.5. A client reports, My friend panicked at the site of spiders. Her therapist used gradual exposure to spiders that initially made her increasingly more anxious. Which technique was the friends therapist most likely using?

ANSWER: C. Systematic desensitization RATIONALE: Systematic desensitization is a treatment for phobias in which a phobic individual is gradually exposed to increasing amounts of the phobic stimulus while practicing relaxation techniques. Eventually, the phobic stimulus causes little or no anxiety.

11.7. A 30-year-old client seeking therapy states, My mom cries when she is not included in all my social activities and thinks of my friends as her own. How would the nurse describe the boundaries between this family's parent and child subsystems?

ANSWER: C. The boundaries are enmeshed. RATIONALE: With enmeshed boundaries, family members lack individuation and experience exaggerated connectedness. The clients mother is trying to prevent independence by generating feelings of guilt.

15.10. A home health nurse visits an 18-year-old client who lives with his mother. The client has been assessed as having low self-esteem. The nurse refers the client for individual counseling. During the next home visit, which assessed client behavior clearly indicates treatment success?

ANSWER: C. The client tells his mother he plans to buy a dog. RATIONALE: When the client tells his mother he plans to buy a dog, he is making decisions and taking on responsibilities. This indicates an increase in self-confidence and therefore self-esteem.

12.9. A client has undergone psychological testing. With which member of the interdisciplinary team should a nurse collaborate to review these results?

ANSWER: C. The clinical psychologist RATIONALE: The nurse should consult with the clinical psychologist to review psychological testing results for the client. Clinical psychologists can administer, interpret, and evaluate psychological tests to assist in the diagnostic process.

10.11. A nurse believes that the members of a parenting group are in the initial, or orientation, phase of group development. Which group behaviors would support this assumption?

ANSWER: C. The group members compliment the leader and compete for the role of recorder. RATIONALE: The nurse should anticipate that members in the initial, or orientation, phase of group development often compliment the leader and compete for the role of recorder. Members in this phase have not yet established trust and have a fear of not being accepted. Power struggles may occur as members compete for their position in the group.

10.3. During a therapeutic group, which nursing action demonstrates a laissez-faire leadership style?

ANSWER: C. The nurse sits silently as the group members stray from the assigned topic. RATIONALE: The nurse leader who sits silently and allows group members to stray from the assigned topic is demonstrating a laissez-faire leadership style. This style allows group members to do as they please with no direction from the leader. Group members often become frustrated and confused in reaction to a laissez-faire leadership style.

11.8. A nurse enters an inpatient room and finds the family disagreeing about the clients living arrangements after discharge. Which information should the nurse provide when teaching techniques to resolve family conflicts?

ANSWER: D. All family members should respect differing opinions and use compromise and negotiation. RATIONALE: Functional families allow and respect differences among members. They learn to handle differences and conflict through negotiation and compromise.

15.11. A 40-year-old client lives with her parents. She has a high school diploma and works at a low-paying job. Her parents give her a weekly allowance to supplement her income. How should the nurse classify their client- parent boundaries?

ANSWER: D. As enmeshed RATIONALE: The client and her parents are overly dependent. The parents control too many aspects of the clients life. Their boundaries are blurred so that it is hard for the client to differentiate her wants and needs from those of her parents. The client-parent boundaries are enmeshed.

14.3. A client on an inpatient unit is angry with a peer. During lunch, when the peer is not looking, the client spits into his soup. How would the nurse document this interaction?

ANSWER: D. Client is displaying passive-aggressive behaviors. RATIONALE: This response is passive-aggressive. The clients anger is expressed indirectly by spitting in the soup when the peer is not looking.

18.7. A child always chooses to ask mother over father when seeking special privileges. The father is more apt to disagree than agree with the child's requests, whereas the mother usually consents. The child's choice is the result of which component of operant conditioning?

ANSWER: D. Discriminative stimuli RATIONALE: This child is able to discriminate between stimuli. This child can predict with assurance that asking mother (not father) will result in a desired response.

12.2. A client on an inpatient unit angrily states to a nurse, Peter is not cleaning up after himself in the community bathroom. You need to address this problem. Which is the appropriate nursing response?

ANSWER: D. I can see that you are angry. Let's discuss ways to approach Peter with your concerns. RATIONALE: The most appropriate nursing response involves restating the clients feeling and developing a plan with the client to solve the problem. According to Skinner, every interaction in the therapeutic milieu is an opportunity for therapeutic intervention to improve communication and relationship-development skills.

14.18. An aggressive nurse manager tells a staff nurse she has no business rallying staff to change the schedule. What would be an example of a technique that the staff nurse could use to stand up for her basic human rights?

ANSWER: D. I have the right to express my opinion about the schedule. RATIONALE: This response reflects the use of standing up for ones basic human rights.

4.13. Which is the most appropriate nursing reply when a client asks what the goal and benefit are of assertive skills training?

ANSWER: D. It improves communication skills in order to improve interpersonal relationships. RATIONALE: Assertiveness training helps to develop satisfying interpersonal relationships by teaching people how to communicate in a manner to meet their own needs while respecting the rights and needs of others.

10.14. A nursing instructor is teaching students about self-help groups like Alcoholics Anonymous (AA). Which student statement indicates that learning has occurred?

ANSWER: D. Members themselves run the group, with leadership usually rotating among the members. RATIONALE: The student indicates an understanding of self-help groups when stating, Members themselves run the group, with leadership usually rotating among the members. Nurses may or may not be involved in self-help groups. These groups allow members to talk about feelings and reduce feelings of isolation, while receiving support from others undergoing similar experiences.

18.1. A kindergarten rule states that if unacceptable behavior occurs, a child's personalized fish will be moved to the sea grass. Children who behave keep their fish out of the sea grass. The school nurse should identify this intervention as based on which principle of behavior therapy?

ANSWER: D. Negative reinforcement RATIONALE: Negative reinforcement is increasing the probability that behavior (appropriate classroom behavior) will recur by removal of an undesirable reinforcing stimulus (personalized fish in sea grass).

11.11. During family counseling a husband states, Every time my wife and I discuss child discipline, we get into shouting matches. The nurse instructs the couple to shout at each other for 2 weeks on Tuesdays and Thursdays for 30 minutes. What intervention is the nurse using?

ANSWER: D. Paradoxical intervention RATIONALE: In a paradoxical intervention, the therapist requests the family to continue the maladaptive behavior. This removes control over the behavior from the family to the therapist. Clients are made more aware of the defeating behavior and this can lead to behavioral change.

14.8. After vying for a nurse management position, nurse A is chosen over nurse B. When nurse manager A calls for staff meetings, nurse B is chronically late or absent. Nurse B is exhibiting which type of behavior?

ANSWER: D. Passive-aggressive RATIONALE: This response is passive-aggressive. The colleague is expressing anger indirectly by being late or absent from the meetings.

12.10. In the role of milieu manager, which activity should the nurse prioritize?

ANSWER: D. Searching newly admitted clients for hazardous objects RATIONALE: The milieu manager should search newly admitted clients for hazardous objects. Safety of the client and others is the priority. Nurses are responsible for ensuring that the clients safety and physiological needs are met within the milieu.

12.6. A nurse working on an inpatient psychiatric unit is assigned to conduct a 45-minute education group. What should the nurse identify as an appropriate group topic?

ANSWER: D. Stress management RATIONALE: The nurse should identify that teaching clients about stress management is an appropriate education group topic. Nurses should be able to perform the role of client teacher in the psychiatric area. Nurses need to be able to assess a clients learning readiness. Other topics for education groups include medical diagnoses, side effects of medications, and the importance of medication compliance.

18.8. Parents decide to try the nurse practitioners suggestion of time out when their child misbehaves. What teaching should the nurse practitioner provide the parents?

ANSWER: D. Temporarily move your child to an area where behavior is not being reinforced. RATIONALE: A time out is an aversive stimulus or punishment during which the client is removed from the environment where the unacceptable behavior is occurring. Usually during a time out, the person is temporarily isolated so there is no reinforcing attention. This discourages a reoccurrence of the undesired behavior.

11.14. A couple has been married for 20 years. They argue constantly, belittle feelings, and continuously contradict each other. During a therapy session, the nurse documents Marital schism. What does the nurse mean by this documentation?

ANSWER: D. The couple has an incompatible marriage relationship. RATIONALE: A marital schism is a state of chronic disequilibrium and discord. This describes this couples marriage.

10.13. Which group leader activity should a nurse identify as being most important in the final, or termination, phase of group development?

ANSWER: D. The group leader helps the members to process feelings of loss. RATIONALE: The most effective intervention in the final, or termination, phase of group development would be for the group leader to help the members to process feelings of loss. The leader should encourage the members to review the goals and discuss outcomes, reminisce about what has occurred, and encourage members to provide feedback to each other about progress.

11.4. A depressed 21-year-old client has lived with his mother ever since the death of his father 3 years ago. After the client received a college acceptance, the mother repeatedly states, "That's wonderful. I'll be fine all alone." How would the nurse interpret the mothers statements?

ANSWER: D. The mother is using double-bind communication. RATIONALE: The clients mother says she is fine with him going away to college but then tries to make him feel guilty about her being left alone. The client is in a no-win situation because his mother has given a mixed message a double-bind communication.

14.14. An instructor is teaching about assertive rights. Which student statement indicates a need for further instruction?

ANSWER: D. The right to always put oneself first is an assertive right. RATIONALE: This is not an assertive right. An assertive right is to consider others as well as yourself. This student statement indicates a need for further instruction.

14.5. During an assertiveness training group, a client admits to aggressive behaviors. The client asks for suggestions for how to become more assertive and less aggressive. Which is the most appropriate nursing reply?

ANSWER: D. There are several techniques, including I statements, role playing, and thought stopping, that can help promote assertive behaviors and decrease aggressive behaviors. RATIONALE: These techniques promote assertive behaviors and would help diminish aggressive responses.

15.4. In what way should a nurse expect a school-aged child to gain positive self-esteem, according to Eriksons psychosocial developmental stages?

ANSWER: D. Through receiving recognition when learning, competing, and performing successfully RATIONALE: The school-aged child develops self-confidence by learning, competing, and performing successfully and receiving recognition from significant others, peers, and acquaintances.

10.17. During the sixth week of a 10-week parenting skills group, a nurse observes as several members get into a heated dispute about spanking. As a group, they decide to create a pros-and-cons poster on the use of physical discipline. At this time, what is the role of the group leader?

ANSWER: D. To encourage the group to solve the problem collectively RATIONALE: The role of the group leader is to encourage the group to solve the problem collectively. A democratic leadership style supports members in their participation and problem-solving. Members are encouraged to cooperatively solve issues that relate to the group.

14.22. A client is experiencing high stress. The client states, My boss treats me like a doormat and thinks nothing of demanding frequent overtime. Which nursing intervention would be appropriate?

ANSWER: D. To teach the client how to use I statements RATIONALE: The ability to use I statements is essential in assertive communication. The situation presented indicates that the client needs assertiveness training.

10.6. A single, pregnant teenager in a parenting class discloses her ambivalence toward the pregnancy and the subsequent guilt that these thoughts generate. A mother of three admits to having felt that way herself. Which of Yaloms curative group factors does this illustrate?

ANSWER: D. Universality RATIONALE: The scenario is an example of the curative group factor of universality. Universality occurs when individuals realize that they are not alone in the problems, thoughts, and feelings they are experiencing. This realization reduces anxiety by the support and understanding of others.

14.12. Which best describes a nurses use of assertive behavior?

ANSWER: D. When a nurse is open and direct when asked by the nurse manager to complete assignments RATIONALE: This is an assertive response. There is clear expression of needs and feelings.

18.6. A 2-year-old engages in frequent temper tantrums that usually result in the parents giving in to demands. During family therapy, how should a nurse counsel the parents?

ANSWERS: C. You are positively reinforcing your child's behavior.