mental health exam 1

A nurse needs to encourage a client who is Hispanic and has severe depression to express the client's feelings. What distance between the nurse and the client may help facilitate therapeutic communication?

3 to 6 feet A distance of approximately 3 to 6 feet may help facilitate good therapeutic interaction between the client who is Hispanic and the nurse. People from some cultures, including Hispanics, are more comfortable with less than 4 to 12 feet of space between them when talking. A distance of 10 to 12 inches or 15 to 18 inches is considered the intimate communication zone, which may make the nurse and client feel uncomfortable. A distance of 15 to 18 feet between the nurse and the client is considered the public communication zone, which is unlikely to facilitate therapeutic communication.

When haloperidol is given as a depot injection, it has an effectiveness of which duration?

4 weeks Haloperidol has a duration of 4 weeks.

A client is brought to the emergency department with reports of slurred speech, spasms, and jerky movements. The significant other shows the nurse a pill bottle and states that the client has been taking antipsychotic medications for "awhile". The nurse notices that an "improper dose" is ordered on the prescription bottle. How would the nurse explain what system is causing the movements?

" Dysfunction of the extrapyramidal motor track can manifest serious neurologic symptoms including dystonia, pseudoparkinsonism, and akathisia" The extrapyramidal system is a bundle of nerve fibers connecting the thalamus to the basal ganglia and cerebral cortex. Muscle tone, common reflexes, and automatic voluntary motor functioning are controlled by this nerve track. Dysfunction of this motor track can manifest serious neurologic symptoms including dystonia, pseudoparkinsonism, and akathisia. The term pyramidal tracts refers to upper motor neurons that originate in the cerebral cortex and terminate in the spinal cord (corticospinal) or brainstem (corticobulbar). Pyramidal signs basically mean plantar extension and hyperreflexia. The role of the primary motor cortex is to generate neural impulses that control the execution of movement. You can end up paralyzed on the opposite side of the lesion (so damage the left side means paralysis on the right side), fully paralyzed, or difficulty to learn and select the right movement for the action you want. The corticospinal tract is a descending tract of the spinal cord which contains bundles of axons which originate in the cerebral cortex and descend to synapse within the brainstem or spinal cord. If fibers of the corticospinal tracts are damaged anywhere along their course from the cerebral cortex to the lower end of the spinal cord, this will give rise to an upper motor neuron syndrome. A few days after the injury to the upper motor neurons, a pattern of motor signs and symptoms appears, including spasticity, hyperactive reflexes, a loss of the ability to perform fine movements, and an extensor plantar response known as the Babinski sign. Symptoms generally occur alongside other sensory problems. Causes of damage may include masses such as strokes, subdural hemorrhage, abscesses and tumors, inflammation such as meningitis and multiple sclerosis, and trauma to the spinal cord, including from slipped discs.

A nurse is caring for a child with attention deficit hyperactivity disorder (ADHD). The nurse is teaching about effective administration of methylphenidate to the parents. What education given by the nurse is appropriate?

"Administer the drug early in the morning." Insomnia is a common side effect associated with methylphenidate. The drug should be administered early in the morning to combat insomnia. Unlike with atomoxetine, nausea and vomiting are not the side effects of methylphenidate. Unlike with clonidine, dizziness is not known to be a side effect associated with methylphenidate. Appetite suppression is another side effect associated with this drug. If the drug is administered before breakfast or lunch, it would limit dietary intake. Therefore the drug should be administered along with breakfast to maintain good dietary intake.

When a client states, "I will solve my own problems without asking my family for help," which response by the nurse demonstrates a therapeutic use of self?

"Asking for help from those who care about us isn't a sign of weakness." The correct response by the nurse demonstrates the ability to use the self as a therapeutic tool in order to help the client grow, change, and heal. Telling the client that being self-sufficient is a sign of mental health stability is an automatic response and would cut off further exploring of the client's perceptions. Telling the client the family would want to help when there is a problem is making an assumption without first discussing the client's perceptions. Asking the client how the client plans to manage problems without help communicates sympathy and the need for dependency.

The nurse is asking a client for feedback on the services provided in the hospital. The client responds, "Yeah. It was great." The client spoke in a disgusted and hurried tone and did not make eye contact with the nurse. What is the message conveyed here?

"Don't waste my time asking about your services." The client uses a hurried and disgusted tone of voice; moreover, the client makes no eye contact with the nurse. This process is incongruent with the client's statement. The message conveyed is one of unwillingness to answer the questions asked by the nurse. This incongruence suggests that the client was not sincere about the "greatness" of the services provided. The client's statement does not provide sufficient information to determine if the services were not good.

The manager determines that a nurse is using motivational interviewing when talking with a client. Which statment made by the nurse did the manager observe to make this clinical determination?

"How important is it to you to stop drinking?" There are specific features of motivational interviewing that should appear every time the technique is used. These features include rolling with resistance, proficiency with empathy, negotiating change plans, and eliciting and strengthening client change talk. One additional feature is that of switching flexibility between motivational interviewing and other intervention styles.

A psychiatric-mental health client tells the nurse, "The doctor hates me. The doctor promised to try to come and check on me after dinner yesterday but never came." What is the nurse's mosttherapeutic response?

"I don't know why the doctor didn't come, but I can reassure you that it's not because she hates you." Because the nurse can be confident that the physician's actions are not motivated by hate, the use of doubt is justified. It would be inappropriate for the nurse to characterize the physician to the client as someone who "doesn't keep promises." The nurse cannot justifiably reassure the client that the physician will come as soon as the doctor is able. Similarly, it would likely be inappropriate for the nurse to page the physician solely in response to the client's statement.

The nurse is meeting with a client experiencing a mood disorder. Which client statement indicates that the nurse-client relationship has been established?

"I feel worthless and have no real use in life." People with psychiatric problems often feel alone and isolated. Establishing rapport helps lessen feelings of being alone. When rapport develops, a client feels comfortable with the nurse and finds self-disclosure easier. The nurse also feels comfortable and recognizes that an interpersonal bond or alliance is developing. All of these factors—comfort, sense of sharing, and decreased anxiety—are important in establishing and building the nurse-client relationship. The client stating feelings of worthlessness and having no real use in life demonstrates comfort with the nurse-client relationship. The other statements indicate that the client is not comfortable with the nurse and does not want to share information or take up much of the nurse's time.

After teaching a client who is prescribed imipramine about the drug, the nurse determines that the education was effective when the client states:

"I need to be careful because the drug can make me sleepy." Imipramine is a tricyclic antidepressant and is associated with sedation, orthostatic hypertension, and anticholinergic effects such as dry mouth and constipation. The client needs to be careful with activities because the drug is sedating. The client should change positions slowly to minimize orthostatic hypotension. Sugarless candies, good oral hygiene, and frequent rinsing of the mouth are helpful to combat dry mouth. A high fiber intake would be appropriate to decrease possible constipation.

A client who is experiencing depression states, "I can't seem to do anything to take care of myself, how can I get going?" What is the nurse's best response?

"I notice it has been a while since you have had a shower." Stating, "I notice it has been a while since you have had a shower," is the correct option. Making an observation helps the nurse verbalize what is perceived. This is therapeutic because sometimes a client may not be able to verbalize or make themselves understood. Stating, "I think you need to take a shower," would be a nontherapeutic statement. This is called advising and entails telling the client what to do, communicating the the nurse knows what is best for the client. Stating, "Don't worry, take as long as you need before you get going," denotes reassuring by the nurse. By saying this, the nurse is communicating that this is not a problem despite the fact that the client is approaching the nurse for support in problem solving. By asking, "Why haven't you taken a shower?" the nurse is requesting an explanation. This is intimidating and the client is likely to become defensive or feel judged and vulnerable.

A psychiatric-mental health nurse has been off of work for the past 4 days, as per the normal work schedule on the unit. On the nurse's first day back, a longterm client says, "I haven't seen you around here since Thursday. How was your time off?" What is the nurse's most appropriate response?

"I've been off for the past four days. What have you done since I last saw you?" The nurse should avoid self-disclosure. Whenever possible, it is more therapeutic to redirect the conversation rather than setting an explicit boundary. Saying, "How do you like to spend your time when you're able to do whatever you like?" redirects the conversation but is less therapeutic because the nurse has ignored the client's question. Asking the client to speculate serves no therapeutic purpose.

The nurse and client are discussing discharge plans. Which statement should the nurse make that demonstrates empathy for the client's fear of returning to a group home environment?

"It can be scary to leave a place that you trust and feel supported." Empathy is the ability to experience, in the present, a situation as another did at some time in the past. It is the ability to put oneself in another person's circumstances and to imagine what it would be like to share their feelings. The nurse does not actually have to have had the experience but has to be able to imagine the feelings associated with it. For empathy to develop, there must be a giving of self to the other individual and a reciprocal desire to know each other personally. The process involves the nurse receiving information from the client with open, nonjudgmental acceptance and communicating this understanding of the experience and feelings so the client feels understood. Acknowledging that leaving the hospital can be scary because the client will miss the trust and support provided demonstrates empathy. Questioning about independence, having the client think about things that can be done in the home versus the hospital, and telling the client to have faith in accomplishments do not demonstrate empathy for the client's fear.

A client says, "Nobody listens to me; even you don't!" Which response is most therapeutic?

"It sounds like you're feeling unappreciated." Reflecting feelings is an effective way to show empathy and facilitate the client's further disclosure. Avoid "why" questions, which cause defensiveness, avoid belittling the client's feelings, and do not defend against the client's belief.

A client brings a spouse to the mental health clinic with reports that the spouse has been exhibiting a tendency to self-mutilate, experiences fits of intense rage, and is increasingly aggressive toward others. How should the nurse elaborate on the type of symptoms this client is demonstrating?

"Lack of serotonin in the body produces symptoms such as aggression, hostility, and compulsiveness." Serotonin plays a role in emotions, cognition, sensory perceptions, and essential biologic functions such as sleep and appetite. Serotonin also controls food intake, irritability, sleep and wakefulness, compulsiveness, temperature regulation, pain control, sexual behaviors, and regulation of emotions. Norepinephrine, histamine, and dopamine are not correct. Lack of norepinephrine may lead to conditions such as attention deficit hyperactivity disorder, depression, and hypotension. Lack of histamine means dopamine levels will be elevated and this may result in anxiety, paranoia, being suspicious, and hallucinations. Lack of dopamine may lead to imbalance difficulties, speech problems, and postural changes.

A nurse is providing community education about the prevention of mental illness. In response to the question, "What does it mean to be mentally healthy?" which is the nurse's best response?

"Mental health is marked by productivity, fulfilling relationships, and adaptability." Mental health means the successful performance of mental function, resulting in productive activities, fulfilling relationships, and the ability to adapt to change and cope with adversity. Mental health provides the capacity for rational thinking, communication, learning, emotional growth, resilience, and self-esteem.

A client on the psychiatric mental health unit has a care plan that includes a break for cigarettes every hour during the afternoon if the client follows the behavioral plan to attend the morning group on anger management. The client asks, "I couldn't get to my group this morning because I overslept. Can I just this one time go for a cigarette now?" Which response by the nurse is mosttherapeutic?

"No, Joe. Your plan says that you need to attend that group in order to have cigarette breaks." Setting firm but fair limits in a matter-of-fact and consistent manner helps clients to establish appropriate boundaries and can increase feelings of security. The nurse describes the client's unacceptable behavior, communicates expected behavior, and offers acceptable alternatives, such as walking with the nurse, talking about feelings and thoughts, or participating in recreational therapy.

A client tells the nurse, "I had to slap my child, I couldn't help that." Which response of the nurse indicates that the nurse is in the state of unknowing?

"What was going on for you when this happened?" The state of unknowing is referred to as the nurse's behavior where the nurse is open to seeing and listening to the client's views without imposing any of the nurse's values or viewpoints. Asking the client about what was happening for the client at the time the action took place indicates that the nurse is trying to know more about the client's behavior without making any judgment. The statement about feeling sorry for the child or asking how the client could slap the child indicates that the nurse has a notion that the client has taken a wrong action. In addition, the statement that punishing the child would make it worse indicates that the nurse has a notion that the client has taken a wrong action. Thus, these responses do not indicate that the nurse is in the state of unknowing.

Which is a result of deinstitutionalization?

A "revolving door" of repetitive hospital admissions One result of deinstitutionalization is the "revolving door" of repetitive hospital admission without adequate community follow-up. There are decreased community resources, and the majority of those who are mentally ill are unable to achieve independence.

Which best describes the scope of what community support services provide?

A wide range of services, from health care and education to housing arrangements, employment counseling, and rehabilitation A community support system creates and delivers community-based care to a specific population that traditionally required long-term hospitalization. It includes a range of services: health care, mental health care, rehabilitation, social networks, housing arrangements, and educational and employment opportunities.

Which individual has experienced the consequences of deinstitutionalization?

A woman who was transferred from a psychiatric hospital to the community because of the hospital's impending closure The process of deinstitutionalization involves moving chronically mentally ill clients from state psychiatric hospitals back to their homes or to community-supervised facilities.

Which client is suitable for psychiatric transitional care services?

An individual being discharged from hospital with residual symptoms of mania A homebound individual with bipolar illness who is having subacute symptoms would be the perfect candidate for home care services. The paralyzed veteran, the adolescent who took an overdose, and the schizophrenic woman under the freeway should receive home care due to the acuity of their situations.

Chlorpromazine is a drug in which classification?

Antipsychotic Thorazine is a first generation antipsychotic medication.

The nurse learns that a new client is a former significant other and an initial session is scheduled for early in the afternoon. Which action should the nurse take to maintain professional boundaries?

Ask to be reassigned because of having a prior personal relationship with the client. Since the nurse had a previous personal relationship with the client, the therapeutic boundary is questionable. The best course of action would be for the nurse to ask to be reassigned. Meeting the client or asking another nurse to attend could blur the professional-personal boundary. When concerns arise related to therapeutic boundaries, the nurse must seek clinical supervision or transfer the care of the client immediately.

What is the difference between traditional and atypical antipsychotics?

Atypical antipsychotics work on dopamine-receptor and serotonin-receptor blockade, whereas traditional antipsychotics work on dopamine-receptor blockade. Atypical antipsychotics work on dopamine receptors and serotonin receptors, thus affecting both positive and negative symptoms of schizophrenia.

Cognitive techniques focus on the client's patterns of which type of thinking?

Automatic Cognitive techniques focus on the client's patterns of automatic thinking, first identifying what he or she is examining of recurrent patterns in everyday life and then testing the validity of these automatic thoughts. Cognitive techniques do not focus on delayed, delusional, or magical thinking.

The nurse is working with a family that has indicated a desire to learn better communication skills. The nurse role-plays assertive communication techniques with each family member. The role-play is an example of which type of family intervention?

Behavioral Behavioral interventions assist family members to interact with one another differently. Behaviorism is a school of psychology that focuses on observable behaviors and what one can do to externally bring about behavior change. It does not attempt to explain how the mind works.

When comparing the theories of mental illness popular in ancient Greece with those popular in the Middle Ages, which is more applicable to the Middle Ages?

Belief in demonic possession and exorcism was common. While some of these answers are true of both ancient Greece and the Middle Ages, belief in demonic possession and exorcism was more common in the Middle Ages.

A client taking lithium comes to the hospital for a 2-week follow-up. The client complains of a hand tremor that keeps from holding a coffee cup and states that the client feels confused, has stomach aches, and trips occasionally. Which would be the most therapeutic intervention of the psychiatric nurse?

Call the client's psychiatrist because her symptoms are indicative of moderate toxicity The client's complaints indicate lithium toxicity and should be reported to the client's physician for possible adjustment of the medication.

A Cuban American client has been prescribed an antipsychotic medication. Which response is most important for the nurse to make to this client?

Call the doctor immediately if you experience any of the side effects we talked about." In general, non-Whites treated with Western dosing protocols have higher serum levels per dose and suffer more side effects. While the other options are not inappropriate, they do not address the issue of the client's increased risk for the development of side-effects.

Coordination of care uses services that enable individualized care. Which type of service is also known as the "broker" model?

Case management Coordinated care is often accomplished through a case management service model in which a case manager locates services, links the patient with them, and then monitors the patient's receipt of these services. This type of case management is referred to as the "broker" model. Crisis intervention, partial hospitalization, and respite residential care are not known as the "broker" model.

The most diverse role for the nurse within community based psychiatric mental health care would most probably be what?

Case manager The nurse as case manager probably is the most diverse role within the psychiatric continuum.

Neurotransmission is important in the function of the CNS. For neurotransmission to occur, how do neurons communicate with other cells?

Chemically The transmission of information between two nerves or between a nerve and a gland or muscle is chemical. Selectively, excitably, and accessibly are incorrect.

A nurse has transferred recently to a forensic practice setting from an acute care medical setting. During the orientation period, the nurse's mentor helps the nurse learn the culture of a forensic setting. The nurse learns to be alert to one of the most dominant barriers to building a therapeutic relationship with forensic clients. What is this barrier?

Clients commonly struggle with trusting others. Recurring themes of power and control, negotiation, and trust building dominate therapeutic interventions in this setting; clients have, in varying degrees, learned to adapt to an environment that rewards distrust, manipulation, and deceit. The criminal history, frequent diagnoses of antisocial and borderline personality disorder, and aggressive interpersonal style of many forensic clients can evoke strong emotional responses, and countertransference and splitting reactions are common.

A nurse working on a psychiatric unit is helping clients to understand how individual perceptions determine a person's response or behavior in stressful situations. Which therapeutic approach is the nurse employing?

Cognitive therapy Cognitive therapy is a psychotherapeutic method used to alter distorted beliefs and problem behaviors by identifying and replacing negative and inaccurate thoughts.

Which would not be considered an impediment to successful discharge planning?

Compliance with the therapeutic regimen Compliance with the therapeutic regimen is not an impediment to successful discharge planning. Criminal or violent behavior, alcohol and drug abuse, and noncompliance with medications are all barriers to successful discharge planning.

A forensic nurse working in a prison must view all clients as people who deserve respect and professionalism. What should the nurse do to enforce this viewpoint?

Conduct ongoing self-reflection and self-awareness. Nurses who are successful in forensic nursing view clients as people who deserve respect and professionalism. Being able to adopt a therapeutic role requires ongoing self-reflection and self-awareness.

Which includes the circumstances or parts that clarify the meaning of the content of the message?

Context Context includes the circumstances or parts that clarify the meaning of the content of the message. Process denotes all nonverbal messages that the speaker uses to give meaning and content to the message. Congruence occurs when the process and content agree. Proxemics is the study of distance zones between people during communication.

Which occurs when the nurse responds to the client based on personal unconscious needs and conflicts?

Countertransference Countertransference occurs when the nurse responds to the client based on personal, unconscious needs and conflicts. During exploration, the client identifies the issues or concerns causing problems. Self-disclosure means revealing personal information, such as biographical data and personal ideas. Transference occurs when the client unconsciously transfers to the nurse feelings he or she has for significant others.

The nurse has a client who seems like the nurse's sister, with whom the nurse has a close and positive relationship. This phenomenon is best characterized by which term?

Countertransference Countertransference refers to an instance when the nurse has preconceived attitudes or feelings toward a patient that stem from prior experience. When feelings, either positive or negative, seem extreme or disproportionate to the circumstances, the nurse should consider whether a transferential reaction has occurred.

Which is an example of secondary prevention in the forensic setting?

Crisis intervention Crisis intervention is considered secondary prevention. Rehabilitation and case management are tertiary preventions. Advocacy is a primary prevention.

Which term is used to refer to signals that encourage effective communication?

Cues A cue is a verbal or nonverbal message that signals key words or issues for the client. An abstract message is an unclear pattern of words that often contains figures of speech that are difficult to interpret. In a concrete message, words are explicit and need no interpretation. A metaphor is a phrase that describes an object or situation by comparing it to something else familiar.

A nursing instructor is reviewing the various biologic theories related to the etiology of depression. Which would the instructor most likely include as being involved when describing psychoneuroimmunology?

Cytokines Psychoneuroimmunology is a recent area of research into a diverse group of proteins known as chemical messengers between immune cells. These messengers, called cytokines, signal the brain and serve as mediators between immune and nerve cells. Neurotransmitters reflect the neurobiologic theories. Hypothalmic axes reflect the neuroendocrine and neuropeptides hypotheses. Genetics is a separate group that addresses the biologic theories for depression.

Which is one common mistake that people working in the helping professions do when applying theory to the therapeutic process?

Develop an overzealous commitment to one form of therapy, ignoring the benefits that other types of therapies may have for a given individual. All theories can contribute beneficial knowledge in various situations. An eclectic approach to care is the most comprehensive and effective.

The nurse recognizes that public education is needed to erode stigma to prevent what?

Discrimination Discrimination against an individual is the greatest negative result of the public's stigma related to mental illness. While labeling an individual based on symptomology is serious, it is not the most detrimental result of the stigma against the mentally ill population. While stereotyping an individual based on symptomology is serious, it is not the most detrimental result of the stigma against the mentally ill population. While devaluing an individual is serious, it is not the most detrimental result of the stigma against the mentally ill population.

Who was responsible for much of the reform of the mental health care system in the 19th century?

Dorothea Dix Dorothea Dix, a vigorous crusader for the humane treatment of clients with mental illness, was responsible for much of the reform of the mental health care system in the 19th century.

Freud's personality theory was based on what?

Drives Freud developed a personality theory based on unconscious motivations for behavior, or drives. His personality theory was not based on social attributes, symbols, or impaired functioning.

The nurse observes that a client has been pacing in the unit's common area with pursed lips and a furrowed brow for the past 15 minutes. What is the psychiatric-mental health nurse's best action?

Engage with the client i to validate why the client is doing this Validation is an important therapeutic communication technique and must precede any interventions, such as redirection or group activities. The nurse should avoid presuming that the client's behavior is motivated by anxiety and must validate whether this is the case.

When the nurse states, "Tell me more about that," the nurse is utilizing which communication technique?

Exploring Exploring is delving further into a subject or area. Focusing is concentrating on one simple point. Accepting is indicating reception. Formulating a plan of action is asking the client to consider kinds of behavior likely to be appropriate in future situations.

Which is the most commonly seen adverse side effect of typical antipsychotics?

Extrapyramidal symptoms and tardive dyskinesia The greatest hazard of typical antipsychotics involves adverse effects, such as extrapyramidal symptoms (EPSs) and tardive dyskinesia. Risk of EPSs and other movement disorders is highest for clients who use older, high-potency neuroleptics, such as haloperidol or perphenazine, for long periods.

Which is not involved in empathy?

Feeling the same emotions that the client is feeling at a given time Empathy is trying to understand the experience of the other person. It is not possible for nurses to feel the actual emotions of the other person.

In terms of causing disability among people aged 15 to 44 years of age in North America, where does mental illness rank?

First Compared with all other diseases, mental illness ranks first in terms of causing disability in the United States, Canada, and Western Europe.

A nurse is engaged in a therapeutic relationship with a client. What should the nurse do in order to ensure therapeutic communication takes place? Select all that apply.

Focus on the client during the interaction Ensure the client's confidentiality Employ theoretically based interventions A nurse engaged in therapeutic communication with a client should follow the principles of therapeutic communication: making the client the primary focus of the interaction; using self-disclosure cautiously and only when it serves a therapeutic purpose; maintaining client confidentiality; implementing interventions from a theoretic base; and avoiding the giving of advice.

A group of students is reviewing the process of verbal communication. The students demonstrate understanding of the information when they identify which as the first component of the process?

Formulation of an idea With verbal communication, typically the person formulates an idea, encodes a message, and then transmits the message with emotion. The message is then received and decoded, and a response is made.

When a client who is generally pleasant and cooperative begins to show aggressive behavior toward most clients in a community care facility, the nurse suspects the client has experienced cerebral trauma. Which brain structure is responsible?

Frontal lobes Frontal lobe damage shows symptoms that include loss of emotional control, rage, violent behavior as well as changes in mood and personality and uncharacteristic behavior. Thus, when a client who is generally pleasant and cooperative begins to show aggressive behavior toward most members of the milieu, the nurse suspects the client has experienced cerebral trauma to the frontal lobe. Temporal, occipital, and limbic lobe damage do not exhibit aggressive behavior or personality changes.

Benzodiazepines increase which neurotransmitter function?

GABA Drugs that increase GABA function, such as benzodiazepines, are used to treat anxiety and to induce sleep. Benzodiazepines do not increase the function of serotonin, norepinephrine, or acetylcholine.

While discussing the CNS, the nursing instructor tells the students that the major inhibitory neurotransmitter in the CNS is what?

GABA Gamma-aminobutyric acid (GABA), which is found in the brain, inhibits nerve activity and is important in preventing over excitability or stimulation such as seizure activity. Acetylcholine, dopamine, and serotonin are not the major inhibitory neurotransmitter in the CNS.

The nurse is planning care for clients in a forensic setting. Which supports a trusting nurse-client relationship?

Health teaching Providing the client with information and guidance on healthy living and maintaining health supports the development of a trusting relationship. Examples include health teaching such as reminding clients about appointments and teaching about medications and side effects. A non-judgmental approach and attitude will help create a trusting, respectful relationship. Clients should be treated equally by listening and keeping commitments. Conducting exercise sessions is not the responsibility of the nurse, and is not considered an activity of daily living in the forensic setting,

When providing care to a client, the psychiatric-mental health nurse is implementing the therapeutic use of self. The nurse is applying the concepts based on the work of which individual?

Hildegard Peplau Hildegard Peplau conceptualized nursing practice as independent of physicians and emphasized the use of self as a nursing tool. Florence Nightingale identified the need to view clients holistically, was sensitive to human emotions, and recommended interactions that today would be classified as therapeutic communication. Dorothea Dix crusaded for the humane treatment of clients with mental illness. Sigmund Freud developed a personal theory based on unconscious motivations for behavior.

Who was the first to introduce the concept of interpersonal relations and the therapeutic relationship?

Hildegard Peplau Hildegard Peplau wrote a publication introducing the concepts of interpersonal relations and the therapeutic relationship within psychiatric-mental health nursing practice.

A nursing assessment of a client who has been diagnosed with neuroleptic malignant syndrome (NMS) would most likely reveal which signs?

Hyperpyrexia, severe hypertension, and diaphoresis Fever, hypertension, and diaphoresis are cardinal symptoms of NMS and should be immediately addressed.

A client is returning from military service and has been diagnosed with post-traumatic stress disorder (PTSD). Dysfunction in which brain structure contributes to the rage and fear experienced in PTSD?

Hypothalamus The hypothalamus is a part of the limbic system, which is sometimes called the emotional brain. The hypothalamus is involved in impulsive behavior associated with feelings of anger, rage, or excitement. The pons connects the cerebellum and the brainstem. The basal ganglia initiates motor function. The corpus callosum is the pathway that connects the two hemispheres of the brain.

A client in the operating room goes into malignant hyperthermia due to an abnormal reaction to the anesthetic. The nurse knows that the area of the brain that regulates body temperature is what?

Hypothalamus The hypothalamus plays an important role in the endocrine system because it regulates the pituitary secretion of hormones that influence metabolism, reproduction, stress response, and urine production. It works with the pituitary to maintain fluid balance through hormonal release and maintains temperature regulation by promoting vasoconstriction or vasodilatation. In addition, the hypothalamus is the site of the hunger center and is involved in appetite control.

A psychiatric client's nurse case manager best explains to the family that case management will facilitate the client's transition back into the community by providing which services?

Identifying and meeting the client's health and human service needs Case management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet an individual client's health and human service needs.

A nurse is developing a community education program for a local women's club on the topic of managed care in mental health. Which would the nurse include as the main focus?

Improved access to less costly services Managed care aims to increase access to care and provide the most appropriate level of services in the least restrictive environment. Efforts focus on providing more outpatient and alternative treatment programs and avoiding costly inpatient hospitalizations. When properly conducted and administered, managed care allows clients better access to quality services while using health care dollars wisely.

A young client with severe depression and signs of hopelessness is seen in the emergency department of a large community hospital. The physician determines the need for a psychiatric consult. After the consult, the care team determines that the client is in need of hospitalization. Where should the nurse expect this client to be admitted?

In-house psychiatric unit Many large hospitals have psychiatric services and, when a patient is in need of treatment, will transfer him or her to the in-house psychiatric unit. The general hospital psychiatric setting is primarily for acute treatment with the main goal of stabilization.

A client with a diagnosis of schizophrenia lacks insight into the illness. The client presents with significantly declined function and is consistently nonadherent with medications. Which medication administration route is best suited for optimal treatment of this client's condition?

Intramuscularly If a client is nonadherent and there is a significant decline in functioning, antipsychotic drugs are most often administered intramuscularly. Antipsychotic medications are not normally administered by the intravenous or subcutaneous routes, and oral administration is more challenging when a client is noncompliant with treatment.

A psychiatric-mental health nurse is working a booth at a local community college job fair. One of the participants comes to the booth and asks the nurse about the different types of conditions for which psychiatric-mental health nurses provide care. Which condition would the nurse most likely include in the response? (Select all that apply.)

Issues involving self-mutilation Self-esteem issues related to loss of a limb Problems associated with family or group isolation Substance use disorders Psychiatric nurses care for clients with a wide range of emotional problems and mental disorders. These nurses, specializing in mental health nursing, are not only experts in caring for persons with a primary diagnosis of a mental disorder but also for those with self-concept and body image issues, developmental crises, co-occurring disorders, end-of-life changes, and emotional stress related to illness, disability, or loss. It is a psychiatric nurse who is called when violence, suicide, or a disaster erupts. Issues involving non-adherence related to low health literacy would be a situation in which psychiatric-mental health nurses would be involved.

Which statement accurately describes the clubhouse model of community-based mental health rehabilitation?

It exists to promote rehabilitation alliance. The clubhouse model exists to promote rehabilitation alliance as a positive force in the members' lives. The focus of this model is on health. Taking prescribed drugs is not a condition for participation. Members make decisions regarding their treatment.

A client diagnosed with schizophrenia has recently become divorced and is living in public housing. How would the DSM-5 best help in planning this client's care?

It is used by the mental health team to identify the psychosocial and environmental factors currently affecting the client. While all the options are correct, the primary benefit the DSM-5 has for effective care planning for this client is that it assists in identifying psychosocial and environmental factors that may affect the client's treatment and prognosis. None of the other options has this direct connection to the client's specialized needs.

The nurse working in a psychiatric institution is researching treatment systems that facilitate effective learning. The nurse believes that effective milieu therapy cannot be practiced in today's institutional settings. What disadvantage related to milieu therapy may have led the nurse to believe this?

It requires clients to have longer lengths of stay. Milieu therapy refers to the method of therapy where the clients take part in group sessions and have client-to-client interactions. This therapy required longer length of stay in the hospital as new clients were paired with clients that had been in the hospital for a period of time. With the advent of managed health care in the 1990s, the length of hospital stays decreased significantly. Open space is not a requirement for this therapy. As this milieu therapy involves interactions between clients, the nurse is not required to be present during the entire session. This form of therapy is least expensive as it just involves communication between clients.

A nurse enters the room of a client who has been on the unit for several weeks. The client states, "I haven't seen you for a while. How were your days off?" What is the nurse's most appropriate response?

It's important to get a break from time to time. How have the last few days been for you? Making a noncommittal and nonspecific statement like "it's important to get a break" and then redirecting the conversation to the patient is the best way to avoid self-disclosure and maintain a therapeutic relationship. Overtly stating that he or she cannot talk about personal matters threatens the rapport between the nurse and patient. The nurse should avoid specifying that he or she spent time with family on days off. Asking the patient to guess about the nurse's activities is of no benefit.

Which correctly describes the primary effect of a selective serotonin reuptake inhibitor (SSRI) antidepressant drug?

Its ability to block the reuptake of serotonin An SSRI antidepressant drug's primary effect typically involves its ability to block the reuptake of serotonin, not the management of the symptomology related to depression, the inhibition of the hormonal cascase, nor the increase in the number of serotonin receptor sites.

Medical insurance coverage for medical illnesses is greater than for psychiatric illnesses. What term best describes this discrepancy?

Lack of parity. Parity refers to the various inequities inherent in any health care system. Many health plans cover the costs of psychotropic drugs at far lower rates than they do for other medications. Health care inequities are largely a result of social values and perceived significance. A gap exists between the most effective treatments available and what people actually receive. It is difficult for clients and families to determine what services are needed and where to find them, which causes limited access to services. Medication noncompliance occurs when clients do not take their medications as prescribed.

A psychiatric-mental health nurse is working as a case manager. The nurse understands that the quality of case management is measured by outcomes that result from what?

Level of functioning Quality is assessed by measuring client outcomes that result from the services, such as level of functioning, community integration, and client satisfaction with the services provided. In the community, the case manager works with clients on a broad range of issues from accessing needed medical and psychiatric services to carrying out activities of daily living. Quality of case management is not measured by improved financial status or provision of the most restrictive environment. Continuum of care spans from illness to wellness states.

To facilitate the understanding of a crisis, which intervention should the nurse employ?

Listen and assist the client to articulate his or her feelings An important part of crisis intervention is helping individuals to develop an accurate understanding of the situation and its potential consequences. This usually involves listening to individuals' accounts of their experience and assisting them to identify and articulate their feelings about what is happening.

A client refuses to interact with a student nurse during a clinical session. Which would be the mosthelpful in the immediate situation? Select all that apply.

Listen to the client Show genuine interest in the client's situation Clients experiencing emotional distress typically welcome the opportunity to have someone listen to them and take a genuine interest in their situation. Having another client assigned to the student nurse instead or asking for help from a colleague may not solve the problem. The student nurse should learn to build skills to manage such situations. Sharing something personal with the client would be ineffective. It is important to remember not to ask questions involving personal matters or to share personal matters initially when attempting to establish a therapeutic relationship.

Which is considered the first-line treatment for bipolar disorder?

Lithium Lithium is considered the first-line treatment for bipolar disorder. Lithium is the most established mood stabilizer.

The Fountain House in New York developed the clubhouse model in the 1940s. Which is an important characteristic of a clubhouse?

Members receive mental health treatment from providers in the community. Members are encouraged and assisted to use psychiatric services, which are usually local clinics or private practitioners. Membership is not time limited. The clubhouse is run entirely by patients with psychiatric illnesses with minimal assistance from mental health professionals. Generally, members do not live in the clubhouse.

Which federal law prevents insurance companies from enforcing annual or lifetime dollar amounts to be paid for mental health care?

Mental Health Parity Act In 1996, Congress passed the Mental Health Parity Act, which eliminated annual and lifetime dollar amounts for mental health care for companies with more than 50 employees. However, substance abuse was not covered by this law, and companies could still limit the number of days in the hospital or the number of clinic visits per year. None of the other options represent a federal law that addresses that issue.

A client receives the first dose of fluphenazine. The next day, during the follow-up appointment, the nurse finds the client is confused and the client's temperature is 103°F, pulse rate is 116 beats per minute, respirations are 34 breaths per minute, and blood pressure is 100/50 mmHg. The nurse should investigate further for which condition?

Neuroleptic malignant syndrome The most serious and potentially fatal side effect of the typical antipsychotics is neuroleptic malignant syndrome, characterized by severe muscular rigidity, altered consciousness, disorientation, dysphagia, elevated creatinine phosphokinase, stupor, catatonia, hyperpyrexia, and labile pulse and blood pressure. This life-threatening condition can occur after a single dose of a neuroleptic; however, it is more common in the first 2 weeks of administration or with an increase in dose. It can continue for up to 2 weeks after discontinuation of the medication.

Which sets professional standards of care?

Professional nursing organization States and provinces grant the legal authority to practice nursing, but professional nursing organizations set standards of care and professional nursing activities.

Which intervention is appropriate for a psychiatric-mental health nurse at the basic level of practice?

Promoting symptom management Basic psychiatric-mental health nurses promote and encourage the maintenance of health and prevention of disorders, assess biopsychosocial functioning, serve as case managers, design therapeutic environments, and promote self-care activities, including medication and symptom management. At the advanced level, psychiatric-mental health nurses deliver comprehensive primary mental health services. Functions include teaching and screening, performing preventive interventions, and evaluating and managing care for people with mental illness.

One goal of transitional care in mental health care is what?

Provide an alternative for inpatient admission The two goals of transitional mental health care are to increase the functionality of the client within the home and to provide an alternative for inpatient admission.

During the mid-20th century, the focus of treatment centered on treating neurotransmitter dysfunction in the brain. As a result hospital stays were shortened due to the introduction of which?

Psychopharmacology Support for the biologic approaches received an important boost as successful symptom management with psychopharmacologic agents became a more widespread possibility in the early 1950s. Psychopharmacology revolutionized the treatment of mental illness and led to an increased number of clients discharged into the community, and the eventual focus on the brain became a key to understanding psychiatric disorders.

Which is a clinical activity of only the advanced practice registered nurse?

Psychotherapy Clinical activities of the advanced practice registered nurse include psychotherapy, community interventions, and clinical supervision. Milieu therapy, crisis intervention, and triage are clinical activities of the psychiatric-mental health registered nurse.

The nurse is providing hygiene care for a 70-year-old client in a nursing home who states that the client does not like the physician. Later, when the physician enters the room, the nurse notes that the client is very friendly with the physician, complimenting the physician's care. Which defense mechanism is this client displaying?

Reaction-formation Reaction-formation is displaying a behavior, attitude, or feeling opposite to that which one would normally exhibit in the same situation. Displacement is unconsciously transferring feelings onto another person or object. Rationalization is trying logically to justify irrational, socially, or personally unacceptable behaviors or feelings. Projection is attributing to another person one's unacceptable thoughts and feelings.

What are some of the goals of psychiatric rehabilitation? Select all that apply.

Recovery from mental illness Personal growth Increased independence Increased involvement in treatment decisions Psychiatric rehabilitation aims at promoting the recovery process of clients with a mental illness. Goals include helping the client recover from mental illness, facilitating personal growth, and increasing client independence and participation in treatment decision-making. These activities, as a result, decrease the number of hospital admissions due to mental illness.

Which are functions of assertive community treatment? Select all that apply.

Reduces inpatient service use Promotes continuity of outpatient care Increases the stability of people with serious mental illnesses Assertive community treatment reduces inpatient service use, promotes continuity of outpatient care, and increases the stability of people with serious mental illness. Assertive community treatment does not increase the likelihood of relapse or decrease the availability of services.

A client demonstrates sexually inappropriate behavior toward a student nurse. What is an effective way for the student to respond while protecting and respecting the client?

Report the incident to staff and the clinical instructor so boundaries can be reenforced with the client. Some clients have difficulty recognizing or maintaining interpersonal boundaries. When a client seeks contact of any type outside the nurse-client relationship, it is important for the student (with the assistance of the instructor or staff) to clarify the boundaries of the professional relationship. The behavior should not be ignored or minimized but rather addressed in a professional, matter-of-fact manner so that the client understands the limits being placed on such behaviors.

The parents of a young adult diagnosed with schizophrenia are providing care for the client in their home. During a home visit, the parents state, "It's been so difficult taking care of our child. We need a break. But our child needs constant supervision." Which would be appropriate for the nurse to suggest?

Respite residential care Sometimes families of a person with mental illness who lives at home may be unable to provide care continuously. In such cases, respite residential care can provide short-term, necessary housing for the client and provide periodic relief for the caregivers. This would be the most appropriate suggestion in this case and would provide the client with the least restrictive environment. Partial hospitalization programs provide treatment to clients with acute psychiatric symptoms who are experiencing a decline in social or occupational functioning, who cannot function autonomously on a daily basis, or who do not pose imminent danger to themselves or others. This would be appropriate if the client was experiencing any of these, but the major concern here is giving the parents some relief. Acute inpatient care is the most restrictive and is reserved for acutely ill clients. Intensive outpatient programs focus on stabilization and relapse prevention for highly vulnerable individuals who function autonomously on a daily basis. This client requires constant supervision.

the nurse is conducting an admission assessment on a client in a forensic setting. Which is a priority care issue?

Risk assessment Risk assessment is an important determination to maintain the safety of the client and others. The data obtained in the risk assessment, including the client's known history, habits, legal status, and triggers, are used to develop an individualized treatment plan. In some institutions, risk assessment determines the type of facility for the client. Discussion of crimes is not appropriate because it may block the development of an effective therapeutic relationship. Conditional release plans are reserved for those individuals who have been stabilized and are not considered a danger. Recovery oriented care is important, but begins after the development of an individualized treatment plan to help the individual maintain optimal mental health after discharge.

Which would not be considered a goal of therapeutic communication?

Self-exploration of feelings by the nurse Self-exploration of feelings by the nurse is not considered a goal of therapeutic communication. Establishing rapport, active listening, and guiding the client in problem solving are goals of therapeutic communication.

A client suffers from low mood and disturbed sleep. This client is most likely experiencing a change in which neurotransmitter?

Serotonin Abnormalities of serotonin are involved in mental depression and sleep disorders. Calcitonin is a hormone produced by the thyroid gland. Melatonin is a peptide hormone not a neurotransmitter. Parathyroid is a gland that secretes parathyroid hormone.

A client is referred to a psychosocial rehabilitation program. When explaining this type of care to the client, what would the nurse emphasize?

Services that promote the client's reintegration into the community Psychosocial rehabilitation or psychiatric rehabilitation programs focus on reintegrating people with psychiatric disabilities into the community through work, education, and social avenues while also addressing their medical and residential needs. The goal is to empower clients to achieve the highest level of functioning possible. Intensive treatment that prepares the client to live in the community reflects the focus of assertive community treatment. Outpatient detoxification provides detoxification services for alcohol and drugs in an outpatient setting. Intensive outpatient programs provide frequent monitoring and social support within a therapeutic milieu to enable the client to remain connected to the community.

Which is not a primary behavior of caring, one of the core values of nursing?

Setting boundaries within the relationship Caring involves giving of oneself for the benefit of the other. Although boundaries are therapeutic, they are not typically seen as an element of caring.

Case management has been proposed as a cost-effective model of psychiatric care for mentally ill clients. Which describes the goal of case management?

Short-term inpatient, crisis stabilization, and community referral Case management is the coordination of the range of available services by a case manager, with the goal of crisis stabilization and maintenance of the client within the community.

A group of psychiatric-mental health nurses are reviewing information about different theorists who have played a role in shaping pyschiatric-mental health nursing practice. The group demonstrates understanding of the information when they identify which theorist as proposing that adult sexuality is an end product of a complex process of development that begins in early childhood and involves a variety of body functions or areas that correspond to stages of relationships, especially with parents?

Sigmund Freud Freud believed that adult sexuality is an end product of a complex process of development that begins in early childhood and involves a variety of body functions or areas (oral, anal, and genital zones) that correspond to stages of relationships, especially with parents. This belief was not associated with Skinner, Erikson, or Sullivan.

A psychiatric-mental health nurse is working on a committee that is developing programs that integrate the objectives for mental health and mental disorders, as identified in Healthy People 2020. Which type of program would be least appropriate?

Single substance abuse treatment programs The objectives of Healthy People 2020 identify the need to increase the proportion of persons with co-occurring substance abuse and mental disorders receiving treatment for both disorders. Thus, single substance abuse treatment programs would be least beneficial. The objectives call for an increase in depression screening by primary care providers, an increase in the proportion of homeless adults with mental health problems who receive mental health treatment, and an increase in the proportion of persons with serious mental illness who are employed.

A nurse is describing the differences between a partial hospitalization program and an intensive outpatient program. Which would the nurse describe as the emphasis of partial hospitalization programs?

Social skills training The treatment activities of the intensive outpatient program are similar to those offered in partial hospitalization programs, but whereas partial hospitalization programs emphasize social skills training, intensive outpatient programs educate clients on stress management, illness, medication, and relapse prevention.

A client is to be admitted to an inpatient psychiatric unit on an involuntary basis because the client has threatened to kill the client's spouse. The nurse should explain to the client's family members that the primary focus of the client's hospitalization is what?

Stabilize acute symptoms The focus of a crisis stabilization stay is to stabilize the client's acute symptoms through medications and behavioral interventions. This type of care usually lasts fewer than 7 days and has a symptom-based indication for hospital admission.

Dorothea Dix's solution to gain humane treatment for the mentally ill population included what?

State hospitals Dorothea Dix, a vigorous crusader for the humane treatment of clients with mental illness, was responsible for much of the reform of the mental health care system in the 19th century. Her solution was state hospitals.

During milieu therapy, nurses offer positive feedback and praise for appropriate behaviors. These actions are essential to which concept of milieu therapy?

Support Providing support is essential to a positive nurse-client relationship. Nurses offer clients encouragement, praise, and positive feedback. Containment involves the provision of basic needs: food, shelter, safety, and security. Validation begins with the first interaction between the nurse and client. Structure within inpatient settings assists in the control and limitation of maladaptive behaviors.

A client is seen in an outpatient mental health clinic for complaints of involuntary tongue movement, blinking, and facial grimacing. This syndrome would be identified correctly as what?

Tardive dyskinesia The symptoms of tardive dyskinesia include involuntary movements of the tongue, facial and neck muscles, upper and lower extremities, and truncal musculature. Neuroleptic malignant syndrome is a potentially fatal reaction manifested by rigidity, high fever, and autonomic instability. Acute dystonia includes acute muscular rigidity and cramping, a stiff or thick tongue with difficulty swallowing, and, in severe cases, laryngospasm and respiratory difficulties. Akathisia is reported by the client as an intense need to move about.

A psychiatric-mental health nurse has developed a therapeutic relationship with a client. Which action would alert the nurse to the possibilty that the relationship may be moving outside professional boundaries? Select all that apply.

The client brings the nurse a baked item for their lunch. The nurse is spending more time with the client than the others in the group. The nurse tells a friend that the nurse is the only one who truly understands this client. Indicators that the relationship may be moving outside professional boundaries are gift giving on either party's part, spending more time than usual with a particular client, strenuously defending or explaining the client's behavior in team meetings, the nurse feeling that he or she is the only one who truly understands the client, keeping secrets, or frequently thinking about the client outside of the work situation.

The nurse is working with a client from the Middle East. The nurse maintains a distance of approximately 13 feet from the client while talking. The client says that the client is uncomfortable when the nurse talks to the client from such a long distance. How should the nurse interpret this statement?

The client feels that the nurse is indifferent toward the client. People from cultures in the Middle East, Asia, and the Mediterranean often are more comfortable with less than 4 to 12 feet of space between them while talking. Thus, it is likely the Middle Eastern client feels that the nurse is behaving indifferently toward the client. If the nurse is aware of behaviors in various cultures, the nurse would interpret it this way. The client not maintaining boundaries is an incorrect interpretation of the client's statement. The client does not convey that the nurse is not doing the job properly. The client does not feel that the nurse is invading the client's personal zone.

A nurse is meeting a client for the first time. The nurse observes that the client smiles appropriately but is using rambling speech while answering the nurse's questions. Which would most likely be the reason for this behavior?

The client is nervous and insecure. In the beginning, clients may deny problems, employ various forms of defense mechanisms, or prevent the nurse from getting to know them. The client is usually nervous and insecure during the first few sessions and may exhibit behavior reflective of these emotions, such as rambling. Additional assessment would be needed to determine if the client was exhibiting symptoms of a disorder. The behavior would not be considered normal. If a social relationship was the goal, the client would be engaging the nurse to find out more about the nurse.

A nurse recently began working with a client in the community. The client arrived 15 minutes late for the last appointment and did not show up for today's scheduled appointment, despite confirming the day before. How should the nurse best interpret this client's behavior?

The client is testing the parameters of the relationship. In the early phases of the nurse-client relationship, lateness and absence often characterize the client's testing of the relationship. This is a well-recognized phenomenon and is not normally interpreted as the client being in denial, receiving treatment elsewhere, or mistrusting the nurse's abilities.

The nurse is caring for a client with severe depression. The client tells the nurse, "I really just want to sleep and not have to wake up." What may the nurse interpret from this covert cue?

The client may have suicidal ideations. Covert cues are often vague messages that require interpretation from the nurse or other health care professional. As the client has severe depression, it is possible the client is discussing suicide. The nurse needs to ask a direct yes or no question to determine if this is truly the case. The nurse may be able to surmise that this client is not discussing sleep, fatigue, or needing a break from stress.

An older adult resident of a group home has been receiving treatment for schizophrenia for several decades. The nurse who oversees care at the facility believes that the resident may be developing tardive dyskinesia. What assessment findings would support this suspicion? Select all that apply.

The client often smacks lips when at rest The client makes repetitive movements with the fingers Tardive dyskinesia is usually characterized by repetitive involuntary movements. Syncope, sleep disturbances, and symptom exacerbation are not suggestive of tardive dyskinesia.

A 22-year-old client with a history of a recent suicide attempt is being treated for depression. Prior to becoming depressed, the client self-describes as "very social and doing well in school." Which of the following long-term treatment goals is best suited for this client?

The client will resume previous level of functioning. The aim now is for clients to recover or to experience a remission and be restored to preillness functioning in various domains, such as occupationally, socially, and educationally.

Which goal for an individual client is consistent with the overall objectives of community support service programs?

The client's functional ability will improve. The goal of community support service programs is to enable those with severe mental illness to remain in the community and function as independently as possible.

Which would be the least optimal environment for therapeutic communication for a client who has difficulty maintaining boundaries?

The client's room If the client is unable to maintain boundaries by expressing inappropriate conversation or physical actions, a more formal or public setting such as an interview room, conference room, or at the end of the hall would be a more appropriate place to maintain therapeutic communication.

Which is necessary as a defining feature in mental illness?

The individual must have difficulties in functioning that cause distress and/or impairment of some type. Mental illness is considered a clinically significant behavioral or psychological syndrome experienced by a person and marked by distress, disability, or the risk of suffering, disability, or loss of freedom. The symptoms of the disorder must be above and beyond expected reactions to an everyday event and not merely a cultural expectation. An individual can be diagnosed with a mental illness and not need psychopharmacological intervention. The individual may or may not acknowledge that he or she is having impaired functioning. The experience and consequences of mental illness are much more complicated than a list of symptoms.

A client expresses worry about the client's child's aggressive behavior. The nurse says "You are in a very challenging situation. Your child's aggressive behavior is very stressful for you, is this correct?" What does this nurse's statement indicate?

The nurse is empathizing with the client. Empathizing is the ability of the nurse to perceive the feelings and emotions that the client is trying to communicate. The nurse's statement indicates that the nurse is trying to perceive the problem by relating the problem with the self. This would help the client to feel comfortable and safe while sharing feelings with the nurse. Sympathy is the ability of the nurse to project his or her concern toward the client. The nurse does not perceive the problem of the client. If the nurse is able to empathize with the client then it indicates that the nurse is showing genuine interest and is listening actively to the client.

During client assessment, the nurse asks the next question as soon as the client finishes answering the previous question. Which most likely explains why the nurse is interacting with the client this way?

The nurse may lack confidence in therapeutic communication. Asking questions as soon as the client finishes answering responding to the previous question is an indicator the nurse is not actively listening to the client's responses. This reflects the nurse's limited confidence in the ability to utilize therapeutic communication skills. The nurse may not understand the client's concerns and may need to spend more time completing the assessment. The nurse should ensure the client is given an adequate amount of time to speak, and the nurse should listen actively and attentively.

A nurse understands that giving positive regard to the client helps in building trust for the nurse. Which actions are appropriate while conveying positive regard? Select all that apply.

The nurse should address the client by name. The nurse should actively listen to the client. The nurse should respond openly to the client. Addressing the client by name, actively listening to the client, and responding openly and honestly to the client conveys positive regard. The nurse cannot practically be present all the time to look after the client. The nurse should try to spend some time with the client. The nurse cannot give the responsibility of planning therapy to the client. The nurse should consider the client's views while planning care. This action would also convey positive regard.

A client reveals in a therapy session that the client has thought about killing a neighbor. What is the therapist's obligation regarding this revelation?

The therapist must notify authorities and the potential victim. As a result of the Tarasoff decision, it is mandatory in most (but not all) states to report any clear threats that psychiatric clients make to harm specific people. Psychiatrists, psychotherapists, and other mental health care providers must warn authorities (if specified by law) and potential victims of possible dangerous actions of their clients, even if the clients protest.

A client is in need of a family-like environment with a high level of support. Which would be mostappropriate?

Therapeutic foster care Therapeutic foster care is indicated for clients in need of a family-like environment and a high level of support. Personal care homes operate within houses in the community. Usually, six to 10 people live in one house with a health care attendant providing 24-hour supervision to assist with medication monitoring or other minor activities, including transportation to appointments, meals, and self-care skills. Board-and-care homes house 50 to 150 people in one location and provide 24-hour supervision and assistance with medications, meals, and some self-care skills. Individualized attention to self-care skills and other activities of daily living generally is not available. In a supervised apartment setting, individuals live in their own apartments, usually alone or with one roommate, and are responsible for all household chores and self-care.

A 54-year-old with severe and persistent mental illness and has been referred to a community support system. What is the basic philosophy behind community support systems?

To address the needs of adults with mental illness and increase their ability to function A community support system is a network of people committed to helping a vulnerable population meet its needs and reach its potentials without unnecessary isolation or exclusion. This basic philosophy of care is meant to address humanely the needs of adults with serious and persistent mental illness, which limits their ability to function in the primary areas of daily living.

Though the client does not exhibit any signs or symptoms of depression, a client's physician has prescribed a low dose of the antidepressant mirtazapine. What is the most likely rationale for the physician's action?

To make use of an off-label application of the medication Off-label prescribing is providing a drug for a different diagnosis, at an unapproved dose, outside the approved age group, for longer than the approved interval, or at a different dose schedule. An example is prescribing mirtazapine to induce sleep.To make use of an off-label application of the medication Explanation:

A nursing student is working with a client who has a history of abusing alcohol. Although the nurse has an aversive feeling toward people who abuse alcohol, the nurse feels that the client is worthy of respect and attention regardless of the nurse's own personal feelings. Which correctly describes the nurse's response to the client?

Unconditional positive regard The nurse needs to treat each person with respect and dignity, regardless of personal value conflicts.

The nurse caring for the client taking clozapine should advocate for monitoring using which diagnostic test?

White blood cell count Use of clozapine requires weekly monitoring of white blood cell (WBC) counts to assess for agranulocytosis. Clozapine suppresses the development of WBCs in 1 to 2% of all clients who take it. If WBC levels decrease significantly from baseline, immediate discontinuation of clozapine is recommended. Clients should never use clozapine with other agents that suppress WBC production, such as carbamazepine.

An older adult reports anxiety and is prescribed diazepam by a family physician. The physician asks the office nurse to explain to the client the problematic side effects of this medication. Which instruction about this drug would be most important for the nurse to emphasize?

You may feel dizzy and be prone to falls after taking this medication." Diazepam is a benzodiazepine and may cause incontinence, memory disturbances, and dizziness in older adults. However, the risk for falls because of dizziness is a major concern, and this information needs to be emphasized with the client.

The nurse is talking with the client and demonstrates concern for the way the client is feeling by using verbal affirmations and paraphrasing to show understanding. What communication techniques are being used by the nurse?

active listening Active listening is refraining from other internal mental activities and concentrating exclusively on what the client says. Self disclosure, empathetic linkages and self awareness are not communication techniques. Empathetic linkages are the communication of feelings. Self-awareness is having a clear perception of your personality, including strengths, weaknesses, thoughts, beliefs, motivation and emotions. Self-disclosure is communication by which one person reveals information like thoughts, feelings, aspirations, goals, failures, successes, fears and dreams, as well as one's likes, dislikes and favorites.

A hospitalized male client who has been taking an antipsychotic medication for 2 weeks begins pacing and walking throughout the unit. He tells the nurse that he "cannot sit still." The nurse documents this finding as:

akathisia. The client's inability to "sit still"; and the client's frequent pacing are termed akathisia, an extrapyramidal effect of the antipsychotic medication. Akinesia is slowed movements. Dystonia involves involuntary muscle spasms that lead to abnormal postures, especially of the head and neck muscles. Pseudoparkinsonism includes rigidity, slowed movements, and tremor.

During the moral treatment period, clients were routinely placed into which environment?

asylums In the moral treatment period (1790-1900), moral treatment and the use of kindness, compassion, and a pleasant environment was adopted. Clients were routinely removed from their communities and placed in asylums, which was thought to be best for their safety and comfort. Community mental health centers, by and large, ignored the legions of people with serious mental illnesses and instead focused on the treatment of those with alcoholism and drug addiction. Clients were not placed in psychosocial rehabilitation centers or group homes during the moral treatment period.

A nurse is reading a journal article about practices involved during the moral treatment movement in psychiatric-mental health care. Which practice would most likely be included as being used during this time?

asylums In the moral treatment period (1790-1900), the use of kindness, compassion, and a pleasant environment was adopted. Individuals with mental disorders were routinely removed from their communities and placed in asylums, which was thought to be best for their safety and comfort. Blood letting, exorcisms and incarceration were not practices associated with the moral treatment period.

During the first meeting with a client, the nurse explains that the relationship is time limited and will end. Which best explains the reason for the nurse's explanation?

beginning the termination process Termination begins on the first day of the relationship when the nurse explains that this relationship is time limited and was established to resolve the client's problems and help him or her handle them. Explaining how the relationship will end is not establishing boundaries or explaining the nurse's role or purpose of the meetings.

Two nursing students are giving a presentation on the limbic system. Which can they accurately include as actions of this brain structure?

behavior This part of the brain seems to be largely responsible for the human aspect of brain function. Drug therapy aimed at alleviating emotional disorders, such as depression and anxiety, often involves attempting to alter the levels of epinephrine, norepinephrine, and serotonin.

A psychiatric-mental health nurse is describing the various programs offered by the local community mental health center. When explaining how these programs work, the nurse would emphasize which concept?

collaboration In today's environment, the traditional medical model, which is viewed as autocratic and paternalistic, is being replaced by a collaborative model whereby mental health professionals work in partnership with consumers to help rebuild their lives. Consumer advocacy efforts have led to the implementation of recovery philosophy and practices.

A nurse is developing a plan of care for a client diagnosed with schizophrenia. The nurse integrates knowledge of this disorder, identifying which neurotransmitter as being primarily involved?

dopamine Abnormally high activity of dopamine has been associated with schizophrenia. Loss of cholinergic neurons is associated with Alzheimer's disease. Decreased norepinephrine is associated with depression; excessive norepinephrine is associated with manic symptoms. Increased serotonin is associated with mania; decreased serotonin is associated with depression and insomnia.

A nurse is in the orientation phase of the nurse-client relationship with a client diagnosed with a mental disorder. When interviewing the client during this first encounter, which information about the client would be most important for the nurse to obtain?

perception of the problem Although information about allergies, hospitalizations, and family history are important in the orientation phase, it is most important for the nurse to ask a client with a mental disorder about the nature of the problem from the client's perspective. Some clients deny that a problem exists; other clients may have misperceptions about the problem.

The nurse is talking with a married client just diagnosed with syphilis. The nurse talks with the client about disclosing the information to the spouse and/or any other sexual partners. The client cries and asks the nurse, "Have you ever had an affair?" The nurse states, "Yes, it usually doesn't turn out well." The nurse proceeds to answer other questions about the affair. By answering these personal questions the nurse is divulging what?

self- disclosure Self-disclosure is letting the client know personal information. The conversation should focus on the client, and not the nurse. On revealing personal information the nurse should be purposeful and have identified therapeutic outcomes. Rapport, empathetic linkages, and self-awareness are not included in self-disclosure.

A female client is brought to the emergency department by her sibling, who reports that the client became very agitated and "started hallucinating." Further assessment reveals tachycardia, incoordination, vomiting, and diarrhea. The sibling states that the client is taking paroxetine for depression. Which would the nurse most likely suspect?

serotonin syndrome The client's symptoms, along with the use of paroxetine (a selective serotonin reuptake inhibitor [SSRI]) suggest serotonin syndrome. Neuroleptic malignant syndrome and acute dystonic reaction would occur with antipsychotic uses. Hypothyroidism may result from lithium use.

Which is often considered the most difficult yet most effective communication technique?

silence Although restating, reflecting, and clarifying are effective therapeutic communication techniques, one of the most difficult but often most effective communication techniques is the use of silence during verbal interactions. By maintaining silence, a nurse allows the client to gather thoughts and to proceed at his or her own pace.

The nurse is determining if a client has a formal system of support. Which person best describes this type of support?

the nurse caring for the client in the nursing home The client's nurse is an example of formal support which is based on an organization that has a purpose of caretaking for an individual. Family member, friends, and neighbors in the community are examples of informal support systems.

A client has begun taking 1 mg of eszopiclone at bedtime, a dose which is considered to be equivalent to a 3.75-mg dose of her previous hypnotic, zopiclone. This comparison of the relative dosages of these two drugs is referred to as what?

Potency Potency of a drug refers to the relative dosage of a drug that is required to achieve a desired effect. Median effective dose is the dosage at which 50% of clients experience a specific therapeutic effect when prescribed a certain psychotropic drug. Clinical efficacy refers to the maximum clinical response achievable by the administration of a specific drug. Tolerance refers to the need for markedly increased amounts of a specific drug over time.

Despite family members' concerns, a client has been discharged home after a recent suicide attempt and a diagnosis of major depression. Which phenomenon has been identified as contributing to reduced lengths of hospital stays in recent years?

Pressures to reduce health care costs associated with inpatient care There is tremendous pressure to reduce the escalating costs of health care, a trend that has often resulted in early discharge and reduced average lengths of stay. This trend toward shorter inpatient courses of care is not a result of the ineffectiveness of inpatient care or improved drug treatments and publicly funded programs.

A drug that is an antagonist functions to do what?

Prevent natural or other substances from activating cell function Drug antagonists block the actions of everything in the agonist spectrum. These chemicals bind to and block a receptor, producing no response and preventing agonists from binding or attaching to the receptor.

During a therapy session, the nurse asks the client, "Tell me more about your relationship with your parents." The nurse is using which therapeutic communication technique?

Probing An example of probing is "tell me more about your relationship with your parents." Reflecting feelings occurs when one identifies feelings that are being expressed. Confrontation is challenging a participant. Clarification is a restatement of the interaction.

When describing the influence of Harry Stack Sullivan on psychiatric-mental health nursing, which would an instructor address as a major concept?

interpersonal relations Harry Stack Sullivan (1892-1949), an American psychiatrist, extended the concept of interpersonal relations to include characteristic interaction patterns. Rogers addressed the concept of unconditional positive regard. Fromm addressed the need for harmony and understanding between an individual and society. Jung addressed the collective unconscious such that individuals had both extroverted and introverted tendencies.

Termination takes place during the resolution phase of a nurse-client relationship. During the termination process, a client brings up resolved problems and presents them as new issues to work toward. The nurse interprets the client's action as indicating what? The client:

is attempting to prolong the nurse-client relationship. It is not unusual for clients with mental disorders to bring up resolved problems and present them as new issues during the resolution phase. The client is most likely attempting to prolong the nurse-client relationship. The client may be experiencing anxiety about the relationship ending. Anger typically would be demonstrated toward the nurse or displaced onto others rather than through the use of bringing up resolved problems. The client's actions do not indicate that additional therapy is needed nor that the therapy was ineffective.

The most important reason that psychiatric nurses need to know about the brain is that ...

it is the organ of the mind and governs all forms of human behavior. As the major organ of the nervous system, the brain governs all behavior of the body, including respiration, locomotion, and sensory activity, as well as cognition, thought, and the actions that constitute our conduct and performance as humans. Nurses need a basic working knowledge of the major neurotransmitters because many psychiatric medications work to increase or decrease neurotransmitter levels in the brain.

A client has entered treatment for substance abuse and psychotherapy. The client asks about what to expect from individual psychotherapy sessions if the client "works really hard at it." The nurse can answer the question most effectively with which response?

"Psychotherapy will help you adapt healthy coping mechanisms." When a client commits oneself for drug rehab therapy and asks what the client can expect from individual psychotherapy sessions if the client "works really hard at it," the nurse answers the question most effectively when responding with the following: "Psychotherapy will help you adapt healthy coping mechanisms." The aim of therapy is to help the client identify the background and triggers for substance abuse and then go on to identify healthy coping mechanism for stressful triggers that fuel the substance abuse. It would be inauthentic to say the client will never return to drug use again as relapse is expected. Although, psychotherapy can help people understand their stage of development, this is not the goal of this process and does not offer the client a practical means to problem solve.

When a 23-year-old client is admitted to the psychiatric unit after a suicide attempt, the client states the client is willing to speak to the nurse but only if the conversation remains confidential. Which is the nurse's best response?

"Will this conversation involve your desire to harm yourself?" Asking whether the conversation will involve the client's desire to hurt the client establishes whether the nurse can keep it confidential. Nurses may find it necessary to reassure a client that confidentiality will be maintained except when the information may be harmful to the client or others and except when the client threatens self-harm. The other options are not necessarily true; if the conversation does not affect the client's health or well-being, there is no reason to share the information with anyone. Further, if the conversation affects the client's health or well-being, it will be shared with the client's health care team. The option regarding the client's trust for the nurse is nursing-centered, not client-centered, and does not address the client's question.

A nurse is speaking to a client with a soft smile and eye contact. Which statement said by the nurse would indicate a congruent message?

"Your hard work and determination has helped you recover." A congruent message is delivered when the actions and the words spoken match. The nurse has a smiling facial expression which indicates that the nurse is happy. The statement that the client's hard work and determination has warded off the disease indicates that the nurse is happy with the outcomes of the client's hard work. A smiling facial expression while saying this statement would deliver a congruent message. The statement that the client should not disturb the other clients in the ward indicates that the nurse is irritated. A smiling facial expression while saying this statement would not deliver a congruent message. The statement that the client should listen to the instructions before starting the exercises indicates a focused approach. A smiling facial expression while saying this statement would not deliver a congruent message. The statement that the client should wait for the medicines to show the therapeutic effect indicates that the nurse has sympathy for the client. A smiling facial expression while saying this statement would not deliver a congruent message.

A client arrives for a scheduled meeting with the nurse. Which statement should the nurse make that indicates the working phase of the relationship?

"Your idea would help prevent this from happening again." In the working phase of the nurse-client relationship, the nurse encourages client to prepare for the future. Saying "your idea would help prevent this from happening again" indicates this phase of the relationship. Thanking the client for arriving on time and not giving out the cell phone number indicate the orientation phase of the relationship. Reminding the client about learning how to handle a problem already indicates the resolution phase of the relationship.

Which mental health clients is most likely to frequently present in the emergency department in hospital?

A 34-year-old person diagnosed with an amphetamine addiction who has overdosed A 34-year-old person diagnosed with an amphetamine addiction who has overdosed is most likely to be seen as a participant of the acute care hospitals "revolving door" phenomena. Due to the chronic and complex nature of dual diagnosis clients, frequent hospital presentations are common and treatment can be challenging. A 26-year-old person diagnosed with obsessive-compulsive disorder experiencing an asthmatic attack, a 16-year-old person diagnosed with borderline personality disorder and an infected wrist laceration, and a 68-year-old person diagnosed with early stage Alzheimer's disease with a second degree burn on the hand are not likely to be qualified in this way.

A nursing instructor is teaching a class about transitional psychiatric care. The instructor determines that additional education is needed when the class identifies which client as appropriate for this care?

A 42-year-old who would like to enter marriage counseling Transitional psychiatric care is appropriate for different age groups. Individuals who most benefit from in-home mental health care include clients with chronic, persistent mental illness or clients with mental illness and comorbid medical conditions that require ongoing monitoring.

A client was diagnosed with bipolar I disorder several years ago. After occasional inpatient admissions surrounding manic episodes over the past few years, the client has been receiving outpatient psychiatric services for the past 12 months. The client's care providers, however, are concerned that these outpatient services are not meeting the client's needs. Which service would best fit this client's needs at this time?

A day-treatment program Day-treatment programs are ideal for clients who are not dysfunctional enough to require psychiatric hospitalization but need more structured and intensive treatment than traditional outpatient services alone can provide. This client is unlikely to meet the admission criteria for long-term care or subacute care and is unlikely to benefit from rehabilitative care.

Which clinical situation provides an example of transference?

A female client with a history of sexual abuse exhibits a profound mistrust of male caregivers. Transference or parataxic distortion occurs when a client exhibits the same attitudes and behaviors with a caregiver as with a significant, seemingly similar person in the client's life

A client has recently been diagnosed with cancer. The client says, "What did I do wrong to get such a disease?" Which nonverbal processes, along with the client's statement, would convey a congruent message? Select all that apply.

A sad facial expression A fearful tone of voice A process refers to the nonverbal messages that the speaker uses to give meaning and context to the overall message. The client is diagnosed with cancer and is grieving. Thus, a sad facial expression and a fearful tone of voice are congruent with having been diagnosed with the disease and worrying about the impending health problems. A cheerful expression, a sarcastic tone of voice, and an erect, confident posture are incongruent with the client's statement to the nurse.

The nurse knows the written instructions for healthcare when a person is incapacitated is called

Advance directive Advance care directives are written instructions for health care when individuals are incapacitated. For people who are gravely disabled ; are found to be incompetent; cannot provide food, clothing, and shelter for themselves even when resources exist; and cannot act in their own best interests may require advance care directives and/or may require appointment of a conservator or legal guardian.

Which is the most restrictive setting in the continuum?

Acute inpatient hospitalization Of the settings listed, acute inpatient hospitalization involves the most intensive treatment and is considered the most restrictive setting in the continuum. Inpatient treatment is reserved for acutely ill clients who, because of a mental illness, meet one or more of three criteria: (1) high risk for harming themselves, (2) high risk for harming others, or (3) unable to care for their basic needs.

Which is the key common element in the various psychotherapeutic approaches?

An effective client-therapist relationship The key common element in the various psychotherapeutic approaches is an effective client-therapist relationship. The nurse-client relationship is critical to the success of the use of any therapeutic modality because the client is unlikely to engage authentically if trust in the relationship is lacking.

Funding agencies determine clients' eligibility for psychiatric home care nursing services. Services will be reimbursed if documentation reflects what?

An inability to leave the home due to chronic physical, psychosocial, or medical problems Criteria for homebound status include: an inability to leave home alone because of physical, psychosocial, or medical problems; a need for assistance and taxing effort to leave home; and infrequent short absences from home only for medical or certain types of personal needs.

In early Christian times, what was thought to cause mental illness?

Demonic control During early Christian times (1-1000), primitive beliefs and superstitions were strong. All diseases were blamed on demons and the mentally ill were viewed as possessed, or under demonic control.

The nurse has been unsuccessful in the psychiatric clinical placement and will be obliged to repeat it next semester. The criteria for passing or failing were based on the Psychiatric-Mental Health Nursing Scope and Standards of Practice, which are?

Descriptions of the responsibilities for which nurses are accountable Standards of practice are authoritative statements used by the nursing profession to describe the responsibilities for which nurses are accountable. They do not have the same standing as laws, and they are not future goals but are instead current standards.

A nurse is reading a journal article about the evolution of psychiatric-mental health nursing. Which individual would the nurse identify as being the first to address the education of psychiatric nursing?

Effie Taylor Linda Richards, the first trained nurse in the United States, opened the Boston City Hospital Training School for Nurses in 1882 at McLean Hospital, a mental health facility (Cowles, 1887). Employees of McLean were recruited into the nursing program to learn to provide physical care for patients with mental disorders who developed medical illnesses. In 1913, Effie Taylor integrated psychiatric nursing content into the curriculum at Johns Hopkins' Phipps Clinic. The first psychiatric nursing textbook, Nursing Mental Disease, was written by Harriet Bailey in 1920. Gradually, nursing education programs in psychiatric hospitals were phased into mainstream nursing education programs. In 1952, Hildegarde Peplau published her landmark work which introduced psychiatric-mental health nursing practice to the concepts of interpersonal relations and the therapeutic relationship.

The nurse is reviewing a client's history, which reveals that the client is participating in a psychiatric rehabilitation program. The nurse understands that which is the goal of this program?

Empower clients to achieve the highest level of functioning possible Psychiatric rehabilitation programs, also termed psychosocial rehabilitation, focus on the reintegration of people with psychiatric disabilities into the community through work, education, and social avenues while addressing their medical and residential needs. The goal is to empower clients to achieve the highest level of functioning possible. In-home detoxification promotes careful detoxification from alcohol and sbstances. The Assertive Community Treatment (ACT) model helps individuals with serious mental illness live in the community. Recovery centers assist in the mental health consumer's journey toward recovery by offering self-help groups and training in daily living. In addition, recovery centers offer illness self-management interventions.

When comparing social interactions with therapeutic interactions, the nurse understands that therapeutic interactions do what?

Encourage personal goal setting Therapeutic interactions are designed specifically to encourage the client to engage in personal goal setting. Personal and intimate activities, favors for others, and constructive dependencies are all inappropriate activities for the nurse-client relationship.

A nurse is conducting a review class for a group of psychiatric-mental health nurses about the changes in psychiatric care that have occurred through the years related to legislation and policy initiatives. The nurse determines that the teaching was successful when the group identifies that supporters of the Community Mental Health Centers Construction Act (1963) believed that institutionalization was contributing to what?

Mental Illness The supporters of the 1963 legislation believed the exact opposite of what Dorothea Dix believed during the previous century. That is, instead of viewing an institution as a peaceful asylum, institutionalization was viewed as contributing to illness. Financial problems declined with deinstitutionalization as federal legislation was passed to provide an income for disabled persons allowing people with severe and persistent mental illness to be more independent financially. Overpopulation was prevented by commitment laws in the early 1970s, making it more difficult to commit people which further decreased the state hospital populations. Medication abuse was not associated with institutionalization

A client with a history of schizophrenia is being treated with olanzapine. Which assessment should the nurse prioritize when planning care for this client?

Metabolic syndrome The use of olanzapine is associated with the development of metabolic syndrome (hyperglycemia, dyslipidemia, and abdominal obesity). Metabolic screening is critical to preventing long term co-morbidities such as type II diabetes mellitus and cardiac disease. With the use of olanzapine, seizures and depression are not common side effects of the drug. Systemic infections are more likely with medications such as clozapine, which have a higher incidence of causing agranulocytosis.

Maintaining a therapeutic environment and promoting growth through role modeling are components of which basic level function?

Milieu therapy A basic level function is milieu therapy, which is the maintenance of the therapeutic environment. Counseling involves interventions and communication. Health teaching is a basic level function, as is case management.

A 55-year-old client is being treated for narcissistic personality disorder. The therapist shows caring and appropriate regard for the client. The therapist's behavior is an example of which concept of behavior theory?

Modeling Modeling involves demonstrating desired behavior patterns to a learner. Therapists model behaviors when they teach social skills, such as caring and appropriate regard for others. The therapist models regard for others with the expectation that the learner will copy that behavior. The caring behavior is then reinforced. Given sufficient practice of the caring behavior paired with its reinforcement, regard for others gradually becomes part of the client's behavioral inventory.

Dietary modifications are most likely necessary when a client is being treated with which antidepressant?

Monoamine oxidase inhibitors (MAOIs) MAOIs are antidepressants that are well known for their multiple drug and food interactions. As such, dietary modifications are necessary. Such modifications are not normally necessary when a client is receiving SSRIs, tricyclic antidepressants, or atypical antidepressants.

A nurse is caring for a client on an inpatient mental health unit of a hospital. The nurse tells the client, "You are scheduled to attend therapy sessions every morning at 9:00 a.m. Please make sure that you complete your morning routine, such as using the restroom, bathing, and eating breakfast, before you come for the sessions." Which phase of the nurse-client relationship does this communication indicate, according to the Peplau's model?

Orientation phase According to the conversation, the nurse is informing the client about the daily schedule of the therapy. This conversation is indicative of the orientation phase of the nurse-client relationship. During this phase, the nurse explains the schedules of meeting, identifies the client's problems, and clarifies the expectations of the client. In the identification phase, the client tries to find the problems that would affect treatment. In the exploitation phase, the client examines the feelings and responses and tries to develop better coping skills and a more positive self-image. The client starts becoming independent in this stage. In the termination phase, the problems of the client are resolved and the nurse-client relationship comes to an end.

Which type of setting is used for clients who continue to need supervision but not long-term admission?

Partial (day) hospitalization Partial (day) hospitalization programs are for clients who continue to need supervision but not long-term admission.

Which would be most important for the nurse to do in order to maximize client adherence with the discharge plan?

Partnering with the client from the beginning The nurse can optimize discharge plan compliance by partnering with the client from the first encounter. Because clients with mental illnesses may have limited cognitive abilities and residual motivational and anxiety problems, the nurse should explain in detail all after-care plans and instructions to the client.

Which zone is a distance that is comfortable between family and friends who are talking?

Personal The personal zone is the distance that is comfortable between family and friends who are talking. The intimate zone is the amount of space that is comfortable for parents with young children and people who mutually desire personal contact. The social zone is the distance acceptable for communication in social, work, and business settings. The public zone is an acceptable distance between a speaker and an audience.

The mental health nurse instructs a client prescribed phenelzine to avoid aged foods, such as wine and cheese. For which reasons are these instructions important for client safety?

The foods contain tyramine, which may provoke hypertensive crisis. Monoamine oxidase inhibitors contain tyramine, which can trigger hypertensive crisis. The client must be instructed to avoid all aged foods. None of the other options provide accurate information about the association of the medication and the suggested foods.

The nurse is discussing deinstitutionalization of mentally ill persons at a community forum. What is a consequence of the trend towards deinstitutionalization?

The number of persons with mental illness in prison has increased. As the number of state hospitals was dramatically reduced beginning in the 1960s, the number of persons with mental illness incarcerated in jails and prisons increased. Based on the total number of inmates, this means that there are approximately 356,000 inmates with serious mental illness in jails and state prisons. A large number of persons with mental illness are confined to U.S. prisons and jails. Individuals with mental illnesses are at higher risk for arrest than the general population. They are more likely to have encounters with the criminal justice system and be convicted of a crime than those without a mental illness. After they enter the corrections system, female offenders are more likely than male offenders to receive mental health services, and black offenders receive significantly less mental health treatment than similar non-black Americans.

Which observation should lead the nurse manager to recognize that countertransference is affecting the therapeutic effectiveness of an individual nurse on the unit?

The nurse frequently refers to an elderly, cognitively impaired client as "my granny" Countertransference occurs when a mental health care professional redirects his or her feelings toward a client or becomes emotionally entangled with a client, as is occurring with the nurse's "granny." Being asked to the prom by a client is not an example of countertransference but rather reflects a client's misdirected emotion, referred to as transference. Countertransference does not involve the development of a mental illness or the resulting absenteeism. And countertransference does not involve burnout or the desire to expand one's professional

During the 1800s, Pinel believed that the cure for mental illness was ...

moral treatment. During the 1800s, the cure for mental illness was believed to be moral treatment, defined as kindness, compassion, and a pleasant environment. Philippe Pinel was one of the first physicians who began using moral treatment in France.

A client tells the mental health nurse that the client is taking a sewing class to cope with the client's son's move to another state. The use of this adaptive coping skill is an example of which aspect in the therapeutic relationship?

lcient self-exploration When client self-exploration occurs, the nurse encourages the client to learn positive adaptive or coping skills. Self-disclosure refers to the nurse sharing personal information with the client in order to establish trust and improve rapport. Empathy is the ability of the nurse to perceive the meanings and feelings of the client and to communicate understanding to the client. Respect is also a condition essential for a therapeutic relationship to occur; however, it is not reflective of the client's adaptive coping.

While interviewing a client, the nurse imagines what it would be like to be in the client's situation and how it would feel. The nurse is demonstrating:

empathy. Empathy is the ability to experience, in the present, a situation as another did at some time in the past. It is the ability to put oneself in another person's circumstances and to imagine what it would be like to share in those feelings. The nurse need not have had the experience but has to be able to imagine the feelings associated with it. Rapport (interpersonal harmony characterized by understanding and respect) is important in developing a trusting, therapeutic relationship. Nurses establish rapport through interpersonal warmth, a nonjudgmental attitude, and a demonstration of understanding. Self-awareness is the process of understanding one's own beliefs, thoughts, motivations, biases, and limitations, and recognizing how they affect others. Projection is a defense mechanism in which a person falsely attributes to another one's own unacceptable feelings, impulses, or thoughts.

One of the most common ways in which neurotransmitters are deactivated within the nervous system at the neuronal level is:

enzymatic degradation, primarily by monoamine oxidase (MAO). Neurotransmitters are deactivated in one of two ways. They are either broken down by enzymes, primarily the enzyme MAO, or they are returned back into the neuron--a process known as reuptake.

One of the primary reforms accomplished by Dorothea Lynde Dix was the ..

establishment or enlargement of state hospitals. One of the primary reforms accomplished by Dorothea Lynde Dix was the establishment or enlargement of state hospitals to treat the mentally ill. She also was instrumental in the establishment of mental hospitals in England, Canada, and Europe in the 19th century.