Psych ch by ch

One important skill of therapeutic communication is being able to be attentive to what the client is saying both verbally and nonverbally, in a way that communicates interest, caring, and respect. This communication skill is called ____________.

ACTIVE LISTENING...Developing skill in active listening facilitates the client's ability to communicate and promotes establishment of trust in the therapeutic relationship.

A patient who asks for pain medication, after repeated direction that it is not yet time for his next dose, begins pounding on the table and is placed in restraints. This is an example of what crime?____________

Battery is the unconsented touching of another person. Administering restraint without the patient's consent and outside of an emergency situation could bring charges of battery even if harm or injury did not occur.

A client was referred to the crisis intervention center during a state of acute crisis. During the assessment, the client states to the nurse, "I don't need to be here, because I don't have a problem." The nurse ascertains that the client is using which defense mechanism? 1) Denial 2) Displacement 3) Projection 4) Rationalization

Denial

**NEVER ASK THE QUESTION WHY BECAUSE....

Its a communication block

A patient who appears to be very upset asks the nurse if he can talk with her even though the psychiatric unit rule is that patients are to be in bed by 10:00 p.m. and it is now 10:30 p.m. The nurse agrees to spend time with the patient, but a coworker asks why she is bending the rules for any patient. The psychiatric nurse replies, "He obviously needs to talk, and it's just the right thing to do." The psychiatric nurse is operating from which ethical framework? 1) Kantianism 2) Christian ethics 3) Ethical egoism 4) Utilitarianism

Kantianism...Kantianism suggests that it is the principle or motivation on which an action is based that determines whether it is right or wrong. In this case, the nurse acted on the principle that the patient needed to talk and that it is right to respond to that need even if it means "bending a rule."

An inpatient psychiatric unit's nursing staff failed to run the regularly scheduled therapy groups because of staffing problems. The unit manager determines that this action impacts which client right? 1) Right to respectful care 2) Right to receive treatment 3) Right to assert grievances 4) Right to review the treatment plan

Right to recieve treatment

The phase of the therapeutic relationship in which a plan for continuing aftercare is mutually established by the nurse and patient is called ____________.

Termination...When progress has been made toward attaining established treatment goals and the focus changes to planning for the period following treatment, the nurse and patient are in the termination phase of the relationship.

The nurse is educating patients on an alternative therapy which involves passing of the therapist's hands over a person's body to re-pattern energy fields. This complementary therapy is called ____________.

Therapeutic Touch

An initial electroconvulsive therapy (ECT) procedure has been scheduled for a client diagnosed with major depression. After the nurse explains the procedure, the client states, "I'm too scared and can't decide what to do." Which is the appropriate nursing response? 1) "There is no room for concern. You will be all right." 2) "ECT is a safe, effective treatment. There is no degree of risk." 3) "Tell me a little more about your fears." 4) "Let your family make the decision for you."

This therapeutic response explores the client's feelings about fears related to the treatment. The nurse will then be able to provide appropriate information that addresses the client's fears.

Carl develops a fondness for the nurse who is providing diabetic education, because she reminds him of his wife, who is also a teacher. This is an example of what phenomenon that often arises in a therapeutic relationship?____________

Transference

A nurse on the psychiatric unit overhears a mental health technician tell a patient, "I'm going to smack you, if you don't stop talking like that." If the patient pressed charges, it is likely the mental health technician would be charged with ____________.

assault

When a nurse conveys open, honest communication and there is congruence between what the nurse feels and what the nurse says, then the nurse is manifesting a quality of ____________.

genuineness

A client diagnosed with antisocial personality disorder is admitted to the inpatient unit after setting the police chief's house on fire. The client is scheduled for further psychological testing this morning. Which nursing intervention takes priority? 1) Instruct the client about psychological testing. 2) Explore alternatives to pyromania. 3) Limit the client's social interactions. 4) Encourage the client to follow the unit rules.

1

A client diagnosed with chronic alcoholism is suffering from tingling and numbness in the hands and feet. The nurse instructs the client that this may be a result of a nutritional deficiency. Which vitamin supplement may resolve these symptoms? 1) Vitamin B1 2) Vitamin K 3) Vitamin A 4) Vitamin D

1

A client has been experiencing repetitive bouts of anger following a divorce. The client asks, "What are the long-term effects of my continual anger?" Which is an appropriate nursing response? 1) "Prolonged anger can result in depression and low self-esteem." 2) "There are no long-term effects associated with expressions of anger." 3) "Suppressing anger now will enhance future relationships." 4) "Feelings of anger do not have a direct physiological effect on the body."

1

A client is scheduled for electroconvulsive therapy (ECT). Prior to the client's ECT, what should the nurse teach the client? 1) "General anesthesia and a muscle relaxant drug will be used during the treatment." 2) "It will take 4 to 5 hours to recover from the procedure." 3) "ECT has been used since the 1930s. There is absolutely no risk involved." 4) "Permanent memory loss is a major side effect."

1

A client tells the nurse, "You're so much nicer than that mean nurse on nightshift." This statement would be associated with which personality disorder? 1) Borderline 2) Histrionic 3) Schizoid 4) Avoidant

1

A client with a new ileostomy tells the nurse, "I'm disgusting. This ileostomy makes me so ugly." Which of the following nursing diagnoses is most appropriate to address this client's problem? 1) Situational low self-esteem R/T altered body image evidenced by client statement, "I'm disgusting." 2) Risk for complicated grieving R/T loss of normal GI function evidenced by expressions of anger. 3) Altered reality orientation R/T ileostomy. 4) Anxiety R/T cancer of the colon evidenced by ileostomy.

1

A nursing instructor is teaching about suicide risk statistics. Which statement by the student nurse indicates that learning has occurred? 1) "Males of very high socioeconomic status are predisposed to suicide." 2) "Females of Asian-American ethnicity are predisposed to suicide." 3) The majority of people who commit suicide do not have a diagnosable mental illness. 4) People of the Roman Catholic faith have higher suicide rates than rates among Protestants and Jews.

1

An individual with a history of antisocial personality disorder was arrested for driving under the influence of alcohol and causing a serious car accident. Which comment on this behavior would be expected? 1) "It's not my fault." 2) "I'm too ashamed to talk about it." 3) "I just don't remember doing it." 4) "I'm really sorry about all the people I've hurt."

1

As a last resort, an agitated, physically aggressive client is placed in four-point restraints. The client yells, "I'll sue you for assault and battery!" The unit manager determines that the nurses are protected under which condition? 1) The client is voluntarily committed and poses a danger to others on the unit. 2) The client is voluntarily committed and has a history of being a danger to others. 3) The client is involuntarily committed because of a history of violent behavior. 4) The client is involuntarily committed and is refusing treatment.

1

CHAPTER 1

1

Clients in a group setting have had a verbal disagreement about a topic. One client calmly says, "I have a right to express my opinion." How should the nurse respond? 1) "You do have the right to express your opinion." 2) "You may express your opinion, but not while we are having this meeting." 3) "It seems that the rest of the group doesn't appreciate your opinion." 4) "Let's take turns voicing opinions on this subject."

1

Disruption in identity and disruption in memory that are rooted in psychological traumas are examples of dissociative responses. Psychodynamic theory would describe these responses in which of the following ways? 1) An ego defense in the face of overwhelming anxiety 2) A cognitive distortion 3) A learned behavior 4) Factitious

1

During the initial interview with a client in crisis, which intervention should the mental health nurse first implement? 1) Assess the potential for self-harm 2) Assess the adequacy of the client's support system 3) Assess the level of pre-crisis functioning 4) Assess for substance abuse

1

For the past 3 days, a student has skipped classes, cried constantly, and experienced panic attacks. She is now exhibiting difficulty with short-term memory. What crucial information should the nurse initially obtain prior to planning interventions for this student? 1) The student's description of the precipitating stressor 2) The student's usual ability to cope with stress 3) The student's available support system 4) The student's access to community resources

1

Gertrude has been admitted to the hospital for depression and concurrent alcohol abuse. During the assessment, Gertrude gives the nurse detailed accounts about several somatic symptoms she has had that "they've never been able to find a medical reason for." Based on the data provided, which of the following would be an appropriate nursing diagnosis? 1) Ineffective coping 2) Knowledge deficit 3) Impaired memory 4) Risk for suicide

1

John was admitted to the psychiatric unit after threatening to commit suicide if his wife follows through with filing for divorce. Which of these responses by the nurse is most likely elicit further information from the client? 1) "Tell me your feelings about your upcoming divorce." 2) "Are you feeling OK today?" 3) "Why do you feel like you want to kill yourself?" 4) "I hope that you are packed and ready to leave."

1

The nurse is assessing a client for side effects of electroconvulsive therapy (ECT). Which side effects are common and to be expected? 1) Temporary disorientation 2) Enduring memory loss 3) Residual seizure disorder 4) Cardiovascular complications

1

The physician has ordered lithium carbonate for a bipolar client. Which of the following is the best rationale for prescribing this medication? 1) To decrease or eliminate the incidence of manic episodes 2) To control anger and decrease episodes of aggression 3) To decrease the excessive creativity that is troubling to patients with bipolar disorder 4) To diminish anxiety and reduce obsessive-compulsive symptoms that are common in this population

1

The physician prescribes methylphenidate (Ritalin) for a teenager with ADHD. Which of the following is the most likely rationale for using this medication? 1) To increase the client's attention span 2) To increase the client's motor activity 3) To decrease the client's fatigue 4) To decrease symptoms of psychosis

1

Which characteristic is most essential for the nurse to communicate when establishing a trusting therapeutic nurse-client relationship? 1) Genuineness 2) Confrontation 3) Catharsis 4) Giving advice

1

Which goal should a nurse recognize as being most appropriate for a client experiencing a crisis situation? 1) To restore the client to pre-crisis functioning 2) To prescribe psychotherapy 3) To evaluate the effects of early childhood development on the crisis response 4) To provide a list of support resources

1

Which is characteristic of the African American culture? 1) African Americans often exhibit a strong religious affiliation. 2) Personal space tends to be larger than that of the dominant culture. 3) Women head approximately 25% of all African American households. 4) In the Deep South, an African American folk practitioner is known as a shaman.

1

Which statement explains why nurses should be well versed in techniques to promote client relaxation? 1) Nurses work with anxious clients in all areas of nursing. 2) Stress can be eliminated by appropriate nursing interventions. 3) Stress is a response only to negative events, and these typically occur in a health-care setting. 4) Nurses assist clients to avoid stress that can cause physical illnesses.

1

John is admitted to the psychiatric unit with a diagnosis of Major Depressive Disorder. He attributes this depression to his wife having recently asked for a divorce. He states "Ever since then, I have felt like I'm no good to anybody and she gets to take my kids away from me, too." Which aspects of positive self-esteem have been interrupted as evidenced by John's statements? Select all that apply. 1) Sense of power 2) Sense of significance 3) Sense of virtue 4) Sense of competence

1, 2

People with schizoid and schizotypal personality disorders share which of the following features in common? Select all that apply. 1) Lack of close friends or confidants 2) Odd or eccentric behaviors 3) Ideas of reference 4) Bodily illusions

1, 2

Sandy's coworker sends her a text message that states, "The patient we both cared for yesterday is really mad. Did you give him enough pain medication?" Which of the following aspects of communication are missing from this message that will make it difficult for Sandy to assess its real meaning? Select all that apply. 1) Paralanguage 2) Nonverbal communication 3) Touch 4) Written communication

1, 2

Sandy has been hospitalized after expressing suicide ideation and is diagnosed with borderline personality disorder. The nurse notices during the admission assessment that Sandy has made several superficial cuts on her arms and legs. Which of the following are recommended nursing interventions in response to this self-mutilation? Select all that apply. 1) Provide care for wounds, using a matter-of-fact approach without offering sympathy or additional attention. 2) Remove dangerous objects from the patient's environment. 3) Avoid discussing with Sandy the feelings that trigger episodes of cutting herself. 4) Avoid observing Sally's behavior.

1, 2 Feedback 1: Minimizing attention to the undesired behavior may decrease the repetition of its use. Feedback 2: Safety is a priority, so removing dangerous objects from the environment is an important intervention. Feedback 3: Discussing the feelings that precipitate episodes of self-mutilation may help the patient develop insight and healthier coping strategies. Feedback 4: Observing Sally's behavior is an important intervention to ensure patient safety.

In studying for the National Council of State Boards NCLEX exam, a student concludes that psychiatric nursing is accountable to which of the following ethical codes or guidelines? Select all that apply. 1) American Nurses Association Code of Ethics for Nurses 2) American Hospital Association's Patient's Bill of Rights 3) Bill of Rights for Psychiatric Patients 4) Nurses' Bill of Rights 5) American Medical Association Code of Ethics

1, 2, 3

The nurse has provided care for the victim of a sexual assault. Which of the following are essential aspects of this care that the nurse should evaluate? Select all that apply. 1) Appropriate handling of evidence 2) Information provided to the victim about STDs 3) The victim's coping abilities 4) The victim's willingness to take antidepressant medication

1, 2, 3

Which of the following could be predisposing factors leading to violent client behavior? Select all that apply. 1) Alcohol abuse 2) Cushing's disease 3) History of poverty 4) Seasonal affective disorder 5) Dependent personality disorder

1, 2, 3

After failing state boards, a nursing student is taken to the ED following an interrupted suicide attempt. Which of the following assessments provide critical data needed by the nurse to develop this client's plan of care? Select all that apply. 1) Adequacy of situational support 2) Previous coping skills, both adaptive and maladaptive 3) Perceptions of personal strengths and limitations 4) Level of pre-crisis functioning 5) Level of post-crisis functioning

1, 2, 3, 4 Feedback 1: Without adequate situational support, an individual is most likely to feel overwhelmed and alone. This is an important assessment and affects the planning of client care. Feedback 2: Knowledge of a client's coping mechanisms alerts the nurse to potential maladaptive behaviors. During stressful situations, individuals draw on behavioral strategies that have been used in the past. This is important assessment data and affects the planning of client care. Feedback 3: Understanding perceptions of personal strengths and limitations makes the nurse aware of client resources and/or deficits and enables the nurse to plan client care effectively. Feedback 4: When planning client care, the nurse assesses pre-crisis functioning to set realistic expectations based on client ability. Feedback 5: Assessment of post-crisis functioning would occur after the crisis had been resolved. The plan of care related to crisis management would be implemented during, not after, the crisis

Which of the following are steps of the problem-solving model that a nurse uses in the context of a therapeutic relationship? Select all that apply. 1) Identifying and defining the problem 2) Identifying alternative solutions to the problem 3) Weighing advantages and disadvantages of each alternative 4) Trying all alternatives before making final decisions 5) Selecting an alternative

1, 2, 3, 5

Flo has been seeing the nurse at the mental health center because she has been struggling with intense fear of becoming ill. She spends much of her day checking her temperature and palpating lymph nodes for signs of a lump even though there have never been positive findings of illness. Which of the following are appropriate nursing interventions in response to Flo's concerns? Select all that apply. 1) Refer all new physical complaints to the physician. 2) Help the client explore thoughts and feelings associated with her excessive fears. 3) Gently but firmly tell the client from the outset that you will not permit discussion of illnesses. 4) Help the client identify coping strategies she thinks will be useful during times when anxiety and fear are exacerbated.

1, 2, 4

The nurse has been asked to conduct a cultural assessment with a recently admitted psychiatric patient. In order to identify values that typically vary from culture to culture, which of the following questions should be included in the assessment? Select all that apply. 1) What is the patient's comfortable distance from another during interpersonal interaction? 2) Who is the major decision maker in the family? 3) How well does the patient perform on standardized measures of intelligence? 4) From whom does the family usually seek medical assistance in time of need? 5) What is the family's annual income?

1, 2, 4

The nurse is conducting a spiritual assessment with Candace, who was admitted with Major Depressive Disorder, Severe, after a suicide attempt in which she cut both wrists and required sutures. Which of the following questions are appropriate and important to include as part of this assessment? Select all that apply. 1) What is the most important or powerful thing in your life? 2) Do you participate in any religious activities? 3) Why are you depressed? 4) Who are the significant people in your life? 5) Have you considered Catholicism as a way to promote spiritual healing?

1, 2, 4

The nurse is teaching a class on stress management to patients diagnosed with cancer. Which of the following teaching points are evidenced-based information that the nurse should include in this class? Select all that apply. 1) Stress is known to be a major contributor to many illnesses, including cancer. 2) Genetic influences, past experiences, and other patient vulnerabilities influence how a person responds to stress. 3) When deeply relaxed, people are more attentive to distracting stimuli in the external environment. 4) Physiological manifestations of stress include increases in cholesterol, triglycerides, and blood sugar.

1, 2, 4

The nurse is assessing a Joshua, a 25-year-old, at the mental health clinic to determine his degree of risk for suicide. Which of the following statements support that he is in the high risk category for suicide? Select all that apply. 1) "I've been having panic anxiety attacks since last year." 2) "I drink alcohol daily and smoke pot 3 to 4 times per week." 3) "I've got a lot of close family that live nearby; there's only one or two that I can't count on." 4) "My girlfriend kicked me out and I moved in with a girl I met at the bar but she only let me stay for a month. I've been homeless since then." 5) "When I get angry I let it out by breaking objects or taking my car out for a race around the neighborhood."

1, 2, 4, 5

The nurse is performing an assessment on a client who has been admitted after a suicide attempt. Which of the following questions would the nurse include in the initial interview? Select all that apply. 1) "What means did you use to attempt suicide?" 2) "Do you have a family history of any suicides?" 3) "Why did you choose suicide to solve your problems?" 4) "Was this your first suicide attempt?" 5) "How have you coped with stress in the past?"

1, 2, 4, 5

A patient who was admitted for schizophrenia and is exhibiting paranoid ideation begins screaming, "I will sue every one of you nurses for negligence because my house was wire-tapped by the hospital administrator and you didn't report it." The nurse recognizes that decisions about negligence are based on which of the following? Select all that apply. 1) ANA, APNA, and ISPN standards of practice for psychiatric-mental health nurses 2) The patient's ability to prove that he is no longer psychotic 3) Individual state nurse practice acts 4) The nurse's failure to report the patient's complaint to local authorities

1, 3

Sally was admitted to the hospital with paralysis of her right arm. Medical tests reveal the absence of physiological explanations for her symptom. Her family reports that Sally struck her infant son last week, shortly before the symptom developed, but that she sees no connection between the two events. Which of the following would be appropriate nursing interventions in Sally's plan of care? Select all that apply. 1) Ensure that children's services agencies are involved to evaluate the child's safety in the home. 2) Assist Sally with all activities of daily living, since the paralysis is real to her. 3) Encourage Sally to discuss her fears and anxieties. 4) Monitor ongoing physical assessment to ensure that organic pathology is clearly ruled out. 5) Confront Sally with the evidence that she is intentionally feigning her paralysis.

1, 3, 4

Two students fail their introductory nursing course. One student plans to seek tutoring and retake the course next fall. The second student attempts suicide. Which of the following factors could have influenced the development of this student's crisis? Select all that apply. 1) The individual's perception of the event 2) The time of year in which the event occurred 3) The availability of support systems 4) The availability of adequate coping mechanisms 5) The individual's family birth order

1, 3, 4

Tim is being assessed at the community mental health clinic where his sister brought him with concerns that he might be suicidal. He recently lost his teenage son in a tragic automobile accident and commented that he would rather be with his son than here on earth. He admits to thinking of killing himself but denies intent. Which of the following pieces of information shared by Tim during the assessment are considered protective factors that might reduce Tim's risk for suicide? Select all that apply. 1) Tim describes himself as very religious and according to his religious beliefs, suicide is an unforgivable sin. 2) Tim is 70 years old. 3) Tim describes his family as very supportive and his sister adds, "We would do anything to help Timmy get through this." 4) Tim is being treated for prostate cancer. 5) Tim worked for 20 years as a consultant for a company that teaches conflict resolution skills to corporations.

1, 3, 5

A nurse is conducting an assessment in the emergency department with a patient who is diagnosed with schizophrenia and is expressing paranoid ideation. Which of the following actions would promote the development of a trusting relationship with this patient? Select all that apply. 1) Conveying a sense of interest in hearing the patient's concerns, even when he expresses delusional thinking. 2) Gently touching the patient's shoulder and telling him that everyone on the team is on his side. 3) Observing the patient but minimizing communication since communication with a patient who is experiencing paranoia will only worsen the problem. 4) Simply and clearly providing reasons for interventions being conducted by the nurse. 5) Being reliable in following through with interventions that have been communicated to the patient.

1, 4, 5

Paul, a nurse who is working in a hospital psychiatric unit, has been asked to meet with his nurse manager to discuss concerns around patient confidentiality. Which of these behaviors by Paul are breaches of patient confidentiality? Select all that apply. 1) Paul was telling a nurse from another unit that a patient was admitted to the psychiatric unit who they both know socially. 2) Paul reveals to a patient's girlfriend, who is on the unit to visit him, that the patient threatened to kill her if he got the chance. 3) Paul, the nurse in charge of a specific patient, reviewed the chart when the psychiatrist asked for admission history information, even though this patient is also one of his neighbors. 4) Paul told a nurse during shift report that a particular patient was thinking of taking an overdose, even though the patient asked that this information remain confidential. 5) Paul saw a former patient dining with friends at a local restaurant and asked the patient how his antidepressants were working for him.

1, 5 rationale: Feedback 1: The only individuals who have a right to have access to medical information are those involved in their medical care. Since Paul is acknowledging a patient's admission to the psychiatric unit to someone not involved in the patient's care, this is a breach of confidentiality. Feedback 2: Usually, a generalist psychiatric nurse would pass this information on to the psychiatrist or other team members, but if the person to whom a threat has been made could be endangered, the nurse has a duty to warn her. This would not be a breach of confidentiality. Feedback 3: Although Paul might consider asking for a reassignment if providing care for his neighbor is uncomfortable for the patient, since he is involved in the medical care he has a right to access medical information. This is not a breach of confidentiality. Feedback 4: It would not be considered a breach of confidentiality to share vital information with members of the health care team who are directly involved in this patient's care. It would be helpful for Paul to clarify this to the patient, though, to promote trust in their relationship. Feedback 5: By sharing medical information in a social setting where others may not have known this patient was taking antidepressants, Paul has breached this former patient's right to confidentiality.

Which of the following nursing interventions are appropriate when caring for a suicidal client? Select all that apply. 1) Initiate suicide precautions and provide a hazard-free environment. 2) Encourage the client to talk about his or her emotional pain. 3) Help the client identify areas of life that are within his or her control. 4) Provide the client with ample privacy. 5) Allow the client to isolate self.

1,2,3

Janet, who has sought counseling for chronic low self-esteem, begins to recognize that she has trouble establishing healthy boundaries with others. Which of the following statements from her intake assessment likely contributed to her current difficulty? Select all that apply. 1) Janet reports that she was raised in a family where both parents were alcoholics and that they repeatedly abused her physically and verbally. 2) Janet reports that she assumed responsibility for the care of her siblings since her parents were often at the local bar for many hours of the day. 3) Janet is divorced and currently living with a boyfriend of three years. 4) Janet's mother was hospitalized numerous times for depression and suicidal ideation.

1,2,4

A client experiencing lower extremity paralysis is admitted to a medical unit. Extensive tests confirm disability but rule out any underlying organic pathology. The nurse concludes that this is most suggestive of which disorder? 1) Conversion disorder 2) Factitious disorder 3) Illness anxiety disorder 4) Somatic symptom disorder

1....Conversion disorder is a loss or change in body function resulting from a psychological conflict, the physical symptoms of which cannot be explained by any known medical disorder. The situation presented in the question describes a conversion disorder.

A client on an inpatient psychiatric unit has been diagnosed with antisocial personality disorder. The client says to the nurse, "I don't belong in this place with all these loonies. My doctor must be crazy!" Which nursing response is most appropriate? 1) "You are here for a psychological evaluation." 2) "I'm sure your doctor has your best interests in mind." 3) "Why do you think you don't belong here?" 4) "I've ordered your favorite food for lunch. That will make you feel better."

1....This response uses the communication technique of presenting reality. The client has misconceptions that should be clarified by giving reality-based information.

A client diagnosed with a personality disorder is cold, aloof, and avoids others on the unit. The nurse recognizes that this behavior is symptomatic of which personality disorder? 1) Schizoid personality 2) Passive-aggressive personality 3) Borderline personality 4) Antisocial personality

1...A hallmark of the schizoid personality is a marked withdrawal from social contact. The client behaviors presented in the question are indicative of schizoid personality disorder.

The nurse is caring for four clients. On the basis of knowledge and statistics associated with suicidal risk, which client does the nurse recognize as more predisposed to a suicide attempt? 1) 15-year-old male who abuses substances 2) 48-year-old married Asian-American woman 3) 66-year-old Roman Catholic Hispanic woman 4) 80-year-old married Roman Catholic woman

1...Adolescence is a prime age for suicidal attempts, especially among males. It is the third leading cause of death in this age group. Substance abuse increases suicidal risk because of its effect on inhibition and impulse control.

A distraught client is discussing failing NCLEX, the licensure exam for nurses. The client states, "My life is over. I have nowhere to turn." What is the appropriate nursing response? 1) "You say your life is over. Let's discuss what you mean by that." 2) "Your life really isn't over. Many pass the NCLEX the second time around." 3) "You could find another career path, and things would be better." 4) "Don't worry so much; you can take the exam again soon."

1...Failing a major exam is a focal stimulus that is threatening the client's self-esteem. Asking for clarification from the client is a therapeutic response that will assist the nurse to further explore the client's feelings and assess the client's potential for self-harm.

According to the American Nurses Association (ANA) standards of practice for psychiatric/mental health nurses, which specific intervention can be implemented by any psychiatric/mental health nurse generalist? 1) Milieu therapy 2) Psychotherapy 3) Consultation 4) Prescriptive authority

1...Milieu therapy, which is the scientific structuring of the environment in order to effect behavioral change, is a nursing intervention that can be implemented by any psychiatric/mental health nurse generalist.

A client's history reveals a cultural orientation that discourages verbalization of spiritual issues. In light of this fact, what is the best nursing intervention? 1) Create an environment whereby the client's spiritual expressions are acceptable. 2) Question the client about religious preferences. 3) Refer the client to a nondenominational group. 4) Discuss immortality with the client

1...Spiritual development is an important aspect of the personality. A holistic approach to nursing care is provided when the framework of the nurse-client relationship includes spiritual health. Creating a nonjudgmental environment in which the client can safely express spirituality is an important nursing intervention to this end.

Which is the primary nursing goal when establishing a therapeutic relationship with a client? 1) To promote client growth 2) To develop the nurse's personal identity 3) To establish a purposeful social interaction 4) To develop communication skills

1...The goal of a therapeutic nursing interaction is to promote client insight and behavioral change directed toward client growth.

The client presents to the ED after a rape. Which initial nursing response is most appropriate when communicating with this client? 1) "You are safe here." 2) "I'm sorry that this happened to you." 3) "If you give yourself time to heal, things will look better." 4) "In the future, you need to stay away from that high-crime area."

1...The most critical information to convey initially to the client is assurance that the client is now in a safe environment.

As the move-out date to leave the shelter gets closer, a battered wife states, "I'm afraid to leave here. I'm afraid for my safety and the safety of my children." Which nursing statement is most supportive? 1) "This is a difficult transition. Let's formulate a plan to keep you all safe in the community." 2) "It's the policy that clients can live here for only 30 days. Maybe we can ask for more time." 3) "You've had a month to come up with a plan for keeping you and your family safe." 4) "Hopefully, your husband has been in counseling. I'm sure this will work out fine."

1...The nurse is using the therapeutic techniques of reflection and formulating a plan of action. The use of these communication facilitators indicates that the nurse is supportive of the client's feelings and appreciates the need for a safety plan.

A client is being discharged from the inpatient psychiatric unit after a 4-day stay. She was admitted with major depression that was a single episode and moderate. During her stay, she was started on Prozac (fluoxetine) at 40 mg PO qd. The nurse's discharge teaching should include which of the following? Select all that apply. 1) Continue taking Prozac as prescribed. You will continue to see improvement over the next few weeks. 2) Make sure that you follow up with outpatient psychotherapy, as has been arranged. 3) You may be able to discontinue the medication within 6 months to 1 year, but only under a doctor's supervision. However, there is a chance of recurring episodes. 4) You should avoid foods with tyramine, including beer, beans, processed meats, and red wine. 5) You can discontinue the Prozac whenever you feel better.

123

The nurse is teaching a class on anger management and stressing that anger can have positive and constructive functions. Which of the following are positive, constructive functions of anger that should be included in this education? Select all that apply. 1) Anger mobilizes the body for self-defense. 2) Anger, when expressed assertively, serves to increase self-esteem. 3) Anger, when expressed assertively, contributes to conflict resolution. 4) Anger empowers people to intimidate others. 5) Anger, when combined with aggression, can be a powerful stress reducer.

123

Tom was prescribed tadalafil (Cialis) for erectile disorder and asks the nurse for information about side effects. Which of the following are important adverse effects that the nurse should include in medication education? Select all that apply. 1) Vision changes 2) Hearing loss 3) Contraindicated in combination with nitrates such as nitroglycerine 4) Contraindicated in unstable angina 5) Sustained erection greater than 1 hour

1234

Which of the following are contextual factors that influence manifestations of low self-esteem? Select all that apply. 1) The ability to meet expectations of self and others 2) A feeling of control over one's life 3) How one has coped with previous losses 4) One's awareness of and ability to express feelings 5) How one has coped with previous failures

1245

A client has been diagnosed with major depression, borderline personality disorder, and most recently, dissociative identity disorder. One of the client's personalities attempted suicide, leading to the current hospitalization. Which is the priority nursing diagnosis for this client? 1) Altered Social Interactions 2) Risk for Suicide 3) Social Isolation 4) Altered Self-esteem

2

A client has completed an anger management course. Which client statement would indicate that the client has benefited from the course? 1) "I finally understand why my boss causes me to react violently." 2) "I will go for a walk when I begin to feel angry." 3) "It's OK to express anger as long as I don't often get out of control." 4) "I feel much better after going ballistic."

2

A client is distraught about being admitted to a psychiatric unit. Which client statement indicates a need for an immediate nursing intervention? 1) "If this unit wasn't locked, I would leave immediately." 2) "My children would be better off without a crazy mother." 3) "What I need is some strong medication." 4) "My life is spinning out of control."

2

A client is to undergo electroconvulsive therapy (ECT) in the morning. Which nursing intervention is appropriate? 1) Keep the client NPO 24 hours before the procedure. 2) Verify that informed consent has been granted. 3) Ascertain that client has dentures securely in place. 4) Place side rails down for easy access to the restroom.

2

A nurse gave a client 5 mg of haloperidol (Haldol) for agitation. The client's chart was clearly stamped "Allergic HALDOL." The client suffered anaphylactic shock and died. How would the nurse's actions be labeled? 1) The nurse's actions would be labeled as an intentional tort. 2) The nurse's actions would be labeled as negligence. 3) The nurse's actions would be labeled as battery. 4) The nurse's actions would be labeled as assault.

2

A nursing instructor is teaching about human response patterns. Which student statement indicates that further teaching is necessary? 1) "Assertive individuals express feelings openly and honestly." 2) "Nonassertive individuals use 'I' statements and communicate tactfully." 3) "Aggressive individuals violate others' rights to defend their own rights." 4) "Passive-aggressive individuals protect personal rights by indirect aggression."

2

A patient is admitted to the ER following a rape incident. The ER nurse tells the patient she has contacted a forensic nurse to come and assess her. The patient asks what a forensic nurse is. Which of these responses by the ER nurse would be most accurate? 1) This nurse has a law degree and will help you prosecute the perpetrator of this crime. 2) This nurse has special training to provide health care and advocacy that is sensitive to legal issues that may arise. 3) This nurse is a law enforcement officer who will take your statement. 4) This nurse is an expert in criminal behavior and will be determining whether charges need to be brought against you for contributing to this crime.

2

A widow tells the nurse that her husband died 2 years ago. She continues to feel lonely and vulnerable. Which statement by the widow would indicate that she is considering adaptive coping skill changes? 1) "I'm going to deal with my situation by moving to California." 2) "I will find a support group." 3) "I'm mentally healthy. I can solve my own problems." 4) "I'll be OK. I'm just not a people person."

2

Betty has sought counseling for depression and during the assessment states to the nurse, "I'm exhausted and I feel like I'm taking care of everyone else's needs but my own. I don't even know what I need anymore. Even if I did, nobody asks me anyway." Betty is most likely using which style of communication? 1) Passive-aggressive 2) Nonassertive 3) Aggressive 4) Regressive

2

Clients diagnosed with illness anxiety disorder often "doctor shop." Which defense mechanism is at the root of this behavior? 1) Suppression 2) Denial 3) Projection 4) Rationalization

2

In caring for a client diagnosed with borderline personality disorder, which nursing intervention takes priority? 1) Confront client regarding splitting behaviors. 2) Observe the client's behavior frequently. 3) Place the client in strict isolation. 4) Be available to promote dependence.

2

The nurse expects to establish a supportive therapeutic relationship with a client diagnosed with schizoid personality disorder. Which nursing intervention is most appropriate? 1) Employ therapeutic touch. 2) Allow the client's need for distance in a relationship. 3) Encourage participation in intensive group therapy. 4) Assign different nurses each day until the client finds one with whom to relate.

2

The nurse should include which teaching about the tricyclic group of antidepressant medications? 1) Strong or aged cheese should not be eaten while taking them. 2) Their full therapeutic potential may not be reached until 4 weeks of treatment. 3) They should be discontinued after the prescribed period of treatment because of their potential for physical addiction. 4) They should not be given with antianxiety agents.

2

The unit manager needs to meet with a client who is exhibiting escalating hostility. Which would be the most appropriate location for the nurse to meet with this client? 1) The client's room with the door shut 2) A quiet corner of the dayroom 3) The nurses' station 4) The unit's treatment room

2

When assessing a client diagnosed with narcissistic personality disorder, the nurse expects to identify which characteristic behavior? 1) Odd beliefs and magical thinking 2) Grandiose sense of self-importance 3) Pattern of intense and chaotic relationships 4) Submissive and clinging behaviors

2

Which assertive rights and responsibilities are correctly matched? 1) Right: to make mistakes; Responsibility: to listen to others 2) Right: to ask for what you want; Responsibility: to accept another's right to refuse the request 3) Right: to set personal priorities; Responsibility: to accept personal responsibility for mistakes 4) Right: to refuse to justify feelings; Responsibility: to treat others with dignity

2

Which individual is at lowest risk for suicide? 1) A single 65-year-old male dentist 2) A married middle-class woman 3) A male teenager who hunts 4) A 70-year-old Caucasian woman whose father committed suicide

2

Which is a projected outcome of electroconvulsive therapy (ECT)? 1) The client's anxiety disorder should improve. 2) The client's mood will be elevated. 3) The client's visual hallucinations will decrease. 4) The client's personality disorder symptoms will improve.

2

The nurse begins to intervene with a young woman, Kelly, who was a victim of date rape and came to the health center at the recommendation of her college roommate. Kelly reports that she has been unable to study or return to classes since this event and she wants "someone to pay for this." In guiding Kelly through problem solving, which of the following is a recommended approach? 1) Encourage Kelly to engage in any behavior that she senses will lessen her anxiety. 2) Encourage Kelly to discuss changes she would like to make. 3) Instruct Kelly about ways to avoid date rape in the future. 4) Avoid discussion of feelings about aspects of the event that cannot be changed.

2 It is important in crisis intervention, as well as other psychosocial interventions, that patients be given the opportunity to choose the changes they want to make and to choose the coping strategies they will adopt. The nurse can guide and facilitate the problem-solving process but must remember that patient-centered care means allowing the patient to ultimately choose the plan of care and changes desired.

Mario, a 70-year-old man with "Major Depressive Disorder, Severe" and a history of suicide attempts, tells the nurse he no longer wants to take any medications, including insulin and cardiac medication. He adds that he "just wants to die." Which of the following are issues to consider in responding to this ethical dilemma? Select all that apply. 1) The ANA Code of Ethics for Nurses states that nurses are responsible for making individual, independent decisions about whether or not to give a medication, even if the medication needs to be given without patient consent. 2) The AHA Patient's Bill of Rights states that the patient has the right to refuse treatment to the extent permitted by law and to be informed of the medical consequences of his action. 3) There are circumstances where, when certain criteria are met, a person can be forced to take medication without consent. 4) The Bill of Rights for Psychiatric Patients states that psychiatric patients, once hospitalized, forfeit their right to refuse medication.

2, 3

The nurse is developing expected outcomes in care planning for a patient that is hospitalized with major depressive disorder and at risk for self-harm R/T suicidal ideation with an identified method. Which of the following meet criteria for appropriately stated patient outcomes in this care plan? Select all that apply. 1) The patient will report within 3 days that he will never have suicidal thoughts again. 2) By day 2 of the hospital stay, the patient will agree to talk to his nurse before acting on an impulse to harm himself. 3) By day 3 of the hospital stay the patient will identify two resources for support that he can contact after discharge if his depression worsens and his suicidal ideation returns. 4) Within 4 days of the hospital stay the patient will use better methods to explore job opportunities.

2, 3 Feedback 1: Appropriately stated patient outcomes must be measurable, realistic, and linked to the nursing diagnosis, and they must establish a time frame for completion. Although this expected outcome establishes a time frame for completion, the outcome is not realistic. Feedback 2: This expected outcome establishes a time frame for completion, is a realistic expectation, is measurable, and is clearly linked to the nursing diagnosis of risk for self-harm. Feedback 3: This expected outcome identifies a time frame for completion of a measurable, realistic expectation and is linked to the nursing diagnosis. Feedback 4: The outcome has an established time frame for completion, but the evaluation of "better methods" is subjective and not measurable. It is unclear whether exploring job opportunities is directly linked to the nursing diagnosis of risk for self-harm.

One of the participants in an assertiveness training class states "I don't need to use assertive communication. I've always gotten what I need by using an 'iron hand.' Do as I say or there will be hell to pay." The nurse, in an effort to educate about the benefits of assertive communication, should include which of the following facts? Select all that apply. 1) Assertive communication ensures that you will get what you need without violating the rights of others. 2) Assertive communication expresses one's thoughts, feelings, and desires openly and directly in a less defensive posture. 3) Assertive communication attempts to build positive relationships, whereas aggressive communication tends to create barriers. 4) Assertive communication demonstrates respect for the rights of self and others.

2, 3, 4

Which of the following information would the nurse provide the caregivers of a client with a history of multiple suicide attempts who is being treated on an outpatient basis? Select all that apply. 1) Leave the client alone only for short periods of time. 2) Encourage open lines of communication within the family. 3) Prepare the home environment to be free from substances and firearms. 4) Provide an emergency contact number. 5) Schedule counseling appointments weekly to monitor safety risk.

2, 3, 4

The nurse is conducting training for volunteers who will be taking calls on a crisis intervention hotline. Which of these teaching points accurately describes the concept of crisis? Select all that apply. 1) Crises are always precipitated by a pre-existing mental illness. 2) Crisis occurs in all individuals at one time or another. 3) Crisis situations contain the potential for deterioration and long-term problems. 4) Crises are always precipitated by a specific, identifiable event.

2, 3, 4 Feedback 1: People who have mental illnesses may also experience crisis and may be more vulnerable to difficulty coping with stressful situations, but crises are not always a function of pre-existing mental illness. Feedback 2: A basic concept of crisis is that all people experience it at one time or another. Feedback 3: Although crisis situations contain the potential for growth, which is the desired outcome of crisis interventions, unresolved crisis has the potential to precipitate deterioration and myriad mental, physical, and emotional disorders. Feedback 4: A basis concept of crisis that assists the nurse to differentiate crisis from mental illness is that in crisis there is a specific, identifiable event that was markedly distressing and precipitated the patient's presenting symptoms.

The home health nurse has developed a close relationship with a depressed patient that she has been seeing for the past three months. Which of the following behaviors by the nurse are indications that professional boundaries have been jeopardized? Select all that apply. 1) The nurse touches the patient's hand when the patient is crying about the death of her spouse. 2) The nurse shares concerns with the patient about how short-staffed they are at the home health agency and reflects that her boss never listens to her concerns. 3) The nurse offers to take the patient out to lunch on her day off to encourage her to meet her nutritional needs. 4) The nurse takes over the management of the patient's checking account, including making deposits and withdrawals, because the patient states she lacks the energy to do it herself. 5) The nurse accepts a small cash gift from the patient, who states she is just grateful that the nurse has helped her with her finances.

2, 3, 4, 5

A client wants to overcome depression with something other than traditional treatments. Which of the following are classified as alternative therapies that could be useful in treating this client's condition? Select all that apply. 1) Electroconvulsive therapy (ECT) 2) Acupuncture 3) Pet therapy 4) Peppermint 5) St. John's wort

2, 3, 5

An instructor is teaching about the components of self-concept. Which of the following components need to be included in the lesson plan? Select all that apply. 1) Focal stimuli 2) Body image 3) Self-esteem 4) Flexible boundaries 5) Personal identity

2, 3, 5

The nurse is conducting an admission assessment with a Latino American patient who, upon being admitted to the unit, was accompanied by six family members who insist on being present for the assessment. Each of the family members hugs the nurse when she identifies herself as the patient's primary nurse, and the patient's grandmother insists that they pray before the assessment is initiated. Which of the following are appropriate and culturally sensitive responses by the nurse? Select all that apply. 1) "I'm sorry, but HIPAA laws prohibit anyone other than the patient to be present during assessment." 2) "I'll try to find a room where your family can pray before we begin the assessment." 3) Thank the family members for coming and reinforce with the family how valuable their support will be to the patient during her recovery. 4) Instruct the family members that it is not acceptable for them to hug the nurse because it violates professional codes of conduct. 5) Ask the patient what her preferences are and if the patient requests to complete the admission assessment alone, instruct the family members they will need to wait in another area while the assessment is completed.

2, 3, 5

Barry becomes angry when told that his psychiatrist will not be discharging him from the hospital until the next day. He pounds his fists on the table and demands that his doctor be called. His voice is getting louder as he states, "No one is listening to me! I told the doctor yesterday that I needed to be discharged today and he said 'okay.' I'm calling my insurance company and telling them not to pay for this!!" Which of these responses by the nurse are examples of de-escalation techniques? Select all that apply. 1) "Your doctor will be in tomorrow. You just have to wait till then." 2) "Let me see if I can get the doctor on the phone." 3) Touch the patient on the shoulder and offer to get him some coffee. 4) In a calm voice tell the patient to describe the discussion he had with his doctor. 5) Place the patient is seclusion until he appropriately de-escalates.

2, 4

The nurse is performing an initial assessment on a newly admitted client who is oriented to person, place, time, and situation. Which of the following communication techniques would best facilitate obtaining accurate and complete client data? Select all that apply. 1) Asking closed-ended questions 2) Making observations 3) Requesting an explanation 4) Asking open-ended questions 5) Interpreting

2, 4 Feedback 1: Closed-ended questions are questions that can be answered by a one- or two-word response. This would limit the data obtained during this admissions assessment. Feedback 2: Making observations is a facilitative communication technique that encourages the client to recognize his or her specific behaviors and compare perceptions with the nurse. This would help to gather meaningful and relevant information during an admissions assessment. Feedback 3: Requesting an explanation is the communication block that requests the client to provide the reasons for thoughts, feelings, behavior, and events. Asking why can be intimidating and can imply that the client must defend his or her behaviors or feelings. Feedback 4: Open-ended questions are phrased in a way that elicits as much information as possible. A varied and rich body of information can be assessed by the use of such phrases as "Tell me about . . ." or "Describe to me . . ." Feedback 5: Interpreting is a block to communication. When the nurse expresses the meaning of the client's experiences, it discourages the client from independent self-interpretation.

Mr. Johnson is admitted to the geropsychiatry unit for evaluation of behavioral agitation and altered mental status. Which of the following questions are parts of a mental status examination to assess Mr. Johnson's cognitive functions? Select all that apply. 1) "What is your favorite food?" 2) "What year is it?" 3) "How have you been feeling lately?" 4) "Where are you now?" 5) "What does 'No use crying over spilled milk' mean?"

2, 4, 5

The client asks the nurse what is involved with electroconvulsive therapy (ECT). What is the appropriate client teaching? Select all that apply. 1) "It creates a seizure in the brain that lasts no more than 5 to 10 seconds." 2) "It involves placing electrodes on your head." 3) "You will need only one treatment." 4) "You will get a muscle relaxant before the treatment." 5) "You may need maintenance treatments on an outpatient basis."

2, 4, 5

The nurse is developing a care plan for Joe, who was admitted to the inpatient psychiatric unit after attempting to kill himself by hanging. He continues to express suicidal ideation and states "I'll try it again, the next chance I get." Which of the following nursing interventions are appropriate to include in Joe's immediate care plan for suicide risk? Select all that apply. 1) Maintain 15-minute checks at regular intervals throughout the day. 2) Maintain continuous one-to-one observation. 3) Make an agreement with the patient that if he signs a no-suicide contract, all other suicide precautions will be removed. 4) Remove belts, ties, sharp objects, and glass items from patient access. 5) Ensure that patient has swallowed any medication that is being administered.

2, 4, 5

A patient was taken to the emergency department after a friend said he was threatening to make a suicide attempt. As the nurse begins to assess the patient's risk for suicide, the patient denies feeling suicidal but looks away from the nurse and begins to cry. Which of these understandings about communication will assist the nurse in critical thinking about this patient's level of risk? Select all that apply. 1) When a patient says he or she is not feeling suicidal, nurses have to accept their verbal communication as accurate. 2) Interpersonal connectedness occurs through eye contact. 3) It has been estimated that 70% to 80% of message communication occurs nonverbally. 4) Since the patient has communicated a desire to get treatment by coming to the ER, his suicide risk is relatively low.

2,3 Feedback 1: Verbal communication is only one aspect of the message being communicated. It is vital that the nurse assess verbal, nonverbal, and behavioral cues to make a clinical judgment about whether or not the patient is in immediate danger of harm to self. Feedback 2: Interpersonal connectedness does occur through eye contact. The patient's behavior of looking away when he denies feeling suicidal raises a concern that the patient may not be invested in genuine connection with the nurse. Feedback 3: Since 70% to 80% of a communicated message is nonverbal and this patient is looking away and crying, the nurse needs to explore further to assess this patient's risk for suicide. Feedback 4: The reasons this patient came to the ER are unclear, and to assume that the patient is not at risk for suicide because he sought treatment is a potentially dangerous conclusion.

An emaciated client is being treated for alcohol withdrawal. History reveals a poor work ethic, numerous DUIs, and belligerent behavior. The client's wife refuses to accept him back until he commits to sobriety. After detoxification from alcohol, which nursing diagnosis takes priority? 1) Altered social interaction R/T belligerent behavior. 2) Imbalanced nutrition: less than body requirements R/T inadequate intake of solids. 3) Dysfunctional family processes R/T abuse of alcohol. 4) Ineffective role performance R/T poor work ethic.

2..."Imbalanced nutrition: less than body requirements" is the priority nursing diagnosis for this client. After physical stabilization from the effects of alcohol withdrawal has been completed, meeting the physical need of nutrition must be addressed immediately.

Jane, a 25-year-old widow, is admitted after a failed suicide attempt. She states her beloved husband died 3 months ago. Currently, she cannot pay her bills. In the analysis of Jane's current suicidal crisis which of the following factors is present that would increase her risk for suicide? 1) Relevant history 2) A precipitating stressor 3) Life stage issues 4) Altered social interactions

2...A precipitating stressor is an increase in emotional disturbance added to life's stress, such as the loss of a loved person either by death or by divorce, problems in major relationships, changes in roles, or serious physical illness. The client's husband's death 3 months ago and her subsequent financial difficulties can easily be seen as precipitating stressors.

A construction foreman is hospitalized for head injuries sustained in a fall. The foreman states, "How long will I be here? How will I pay my bills, when my wife is due in 2 months?" Which therapeutic nursing response reflects the use of exploring? 1) "You can't pay your bills and your wife is due in 2 months?" 2) "What support systems do you have locally?" 3) "Have you considered exploring workman's compensation?" 4) "I have noticed a steady decrease in your appetite since your admission."

2...Exploring is encouraging the client to delve deeper into a subject. Here, the nurse is helping the client to discover support systems that may help him through this crisis.

A client has a long history of dissociative identity disorder and has 22 known personalities. Which assessment finding would the nurse expect? 1) History of alcohol abuse 2) History of physical, psychological, or sexual abuse 3) Frequent backaches 4) Electrocardiogram (EKG) abnormalities

2...Freud believed that dissociative behaviors occurred when individuals repressed distressing mental contents from conscious awareness. He believed that this mechanism protected the client from emotional pain. It is typical for clients diagnosed with dissociative identity disorder to have histories of physical, psychological, and/or sexual abuse.

A nursing student is learning about schizoid personality disorder. Which statement by the student indicates that learning has occurred? 1) "These individuals have peculiarities of ideation." 2) "These individuals have a profound inability to form personal relationships." 3) "These individuals have an excessive need to be taken care of by others." 4) "These individuals have an unrealistic sense of entitlement."

2...Having a profound inability to form personal relationships is characteristic of clients diagnosed with schizoid personality disorder. These individuals display a lifelong pattern of social withdrawal, and their discomfort with human interaction is apparent.

A patient is admitted to the ER with multiple wounds sustained in a gang fight and dies there. Which of these actions is the most important priority when a patient dies in the ER from unnatural causes? 1) Keep documentation to a minimum to avoid prosecution for malpractice. 2) Contact the legal authorities. 3) Make a public statement to the media. 4) Refer the patient's family to grief support groups.

2...Legal authorities must be notified of all deaths related to unnatural causes.

A client is considering electroconvulsive therapy (ECT) and questions the nurse about the side effects of the treatment. What is the nurse's best response? 1) "The most common side effect is weight gain." 2) "The most common side effects are transient memory loss and confusion." 3) "There are no side effects." 4) "The most common side effect is depression."

2...The most common side effects of ECT are transient memory loss and confusion. The memory loss usually encompasses the immediate pre- and post-treatment time frame. Confusion dissipates quickly.

A hospitalized adolescent client, who has been abandoned by her parents, angrily demands that she be allowed to call her mother. This client has been reluctant to discuss what precipitated the abandonment. Which nursing response explores this client's feelings? 1) "Why do you want to call your mother?" 2) "Before you call, let's talk about the source of your anger." 3) "You have to control your anger before any call is made." 4) "Tell me the details that led up to the abandonment."

2...This response is an example of the therapeutic communication technique of exploring, used to gather further information from the client. The nurse is using this technique in an attempt to gather information about the client's feelings of anger.

Oliver has been referred by his boss to the employee assistance program because of difficulties that have arisen in his relationships with coworkers. During the nurse's intake assessment, which of the following statements by Oliver are consistent with a diagnosis of paranoid personality disorder? Select all that apply. 1) "I work very hard at my job." 2) "I stay away from my co-workers because they'd love to see me fail." 3) "I would have my boss' job if administration promoted people fairly." 4) "I set a trap in my office so I can tell if my coworkers have opened my file cabinets." 5) "I feel bad for my boss, he's been so stressed this last year."

234

Which of the following features typify an individual diagnosed with obsessive compulsive personality disorder? Select all that apply. 1) Generously spends money on self and others 2) Excessively devoted to work and productivity 3) Preoccupied with details 4) Perfectionism interferes with task completion 5) Overly flexible with regard to morals and ethics

234

A client diagnosed with a borderline personality disorder presents to the mental health clinic and demands to see a counselor immediately. Which is the appropriate nursing action? 1) Instruct the client to leave the clinic. 2) Confront demanding behaviors. 3) Explain the rules and set limits. 4) Help the client to come up with solutions to stressful situations.

3

A client diagnosed with a personality disorder tells the nurse, "With my expertise, I could become this hospital's CEO tomorrow." This statement would be associated with which personality disorder? 1) Antisocial personality disorder 2) Paranoid personality disorder 3) Narcissistic personality disorder 4) Passive-aggressive personality disorder

3

A client diagnosed with avoidant personality disorder states, "I've never been close to my daughter. I'm sure she will never have time for me." Which nursing diagnosis applies to this client? 1) Relocation Stress Syndrome. 2) Risk for Violence: Other directed. 3) Social Withdrawal. 4) Fear.

3

A client has not received what was expected for lunch and directs an angry verbal outburst at the nurse. Which is an accurate description of this display of emotion? 1) Anger is a primary emotion that is automatically experienced. 2) Anger is psychological arousal. 3) The expression of anger can come under personal control. 4) Anger and aggression are the same response.

3

A client is about to undergo electroconvulsive therapy (ECT). Which statement most accurately reflects the nurse generalist's role during this procedure? 1) With advanced training, to perform the ECT procedure 2) To administer the general anesthetic during the procedure 3) To administer the ordered preoperative medications 4) To determine the number of ECT treatments

3

A crisis is an internal disturbance. Which correctly describes a characteristic of a crisis? 1) A crisis is chronic in nature. 2) A crisis is universal in nature. 3) A crisis is precipitated by an event that is specific and identifiable. 4) A crisis will eventually lead to psychological growth.

3

A nursing instructor is teaching about the manifestations of low self-esteem. Which student statement indicates the need for further teaching? 1) "An individual with low self-esteem is sensitive to criticism." 2) "An individual with low self-esteem denies past success experiences." 3) "An individual with low self-esteem has increased libido." 4) "An individual with low self-esteem alienates others by self-preoccupation."

3

A soldier experienced the loss of all fellow platoon members during the Vietnam conflict. The soldier was recently admitted after a suicide attempt. According to Hendin, what has influenced this soldier's predisposition to suicide? 1) Anger turned inward 2) Hopelessness 3) Desperation and guilt 4) Developmental stressors

3

A young client has experienced the untimely death of a twin 2 years ago. Because of this loss, the client continually experiences anger and feelings of rage. Which NANDA nursing diagnosis best documents this client's problem? 1) Anger R/T twin's death evidenced by expressions of rage. 2) Risk for Ineffective Coping R/T twin's death evidenced by expressions of rage. 3) Complicated Grieving R/T twin's death evidenced by expressions of rage. 4) Aggression R/T twin's death evidenced by expressions of rage.

3

An individual is using massage therapy to deal with the stress of a divorce. How does massage therapy work to decrease stress? 1) By integrating the physical, mental, and spiritual energies that enhance health and well-being 2) By manipulating the vertebrae into normal positions, thus facilitating energy flow from the brain 3) By relaxing the muscles, improving circulation, and increasing mobility 4) By stimulating the production of beta-endorphins

3

Diane is admitted to the ER with cuts to her face, neck, and arms, which her husband reports are the result of falling into and shattering a window in their home. The forensic nurse is consulted to assess the wounds. What is the rationale for this assessment? 1) The husband is obviously lying, since he spoke for his wife instead of allowing her to explain the injuries. 2) The forensic nurse has special training in conducting lie detector tests to determine whether the husband is lying. 3) The forensic nurse has training to assess patterned injury by differentiating marks such as defense wounds, grab marks, fingernail scratches, and accidental versus purposely inflicted injuries. 4) The forensic nurse can recommend legal actions against the window manufacturer.

3

In order to return a client to a pre-crisis level of functioning, which client information should the nurse initially assess? 1) Incompetency 2) Psychotic episodes 3) Personal strengths 4) Family support

3

In the post-treatment period of electroconvulsive therapy (ECT), which is an appropriate nursing intervention? 1) Monitor vital signs every 30 minutes during the first hour. 2) Place client on back to facilitate comfort. 3) Orient client to time and place. 4) Ambulate immediately to promote adequate circulation.

3

The nurse is caring for four clients. Which client should not be considered a candidate for electroconvulsive therapy (ECT)? 1) A client experiencing mania 2) A client diagnosed with catatonic schizophrenia 3) A client experiencing intracranial pressure 4) A client diagnosed with major depressive disorder

3

The nurse is teaching a patient education class on complementary/alternative therapies. One of the patients asks, "What is the difference between conventional and alternative therapies?" Which of the following are appropriate responses by the nurse? Select all that apply. 1) Alternative or complementary therapies are based on a behavioral, psychosocial, spiritual model rather than a strictly biological model. 2) Complementary and alternative therapies are always safer than conventional medical approaches. 3) Alternative and complementary therapies consider multiple sources of knowledge and truth, whereas conventional therapies rely entirely on scientific evidence. 4) Complementary and alternative therapies are less expensive.

3

When a client has been assaulted, which nursing intervention is critical to protect the physical evidence of the crime? 1) All client clothing should be shaken to expose any other evidence. 2) All client clothing should be placed and sealed in a plastic bag. 3) All client clothing should be collected, dated, timed, and signed. 4) All client clothing should be stored together in a labeled evidence bag.

3

Which client statement would indicate the most severe suicide risk? 1) "I really don't have much to live for, but I'd go to hell if I ended it all." 2) "I have been diagnosed with cancer. My wife is a great help and support." 3) "When I get home I am using my rifle to blow my brains out." 4) "I don't think anyone would care if I wasn't around anymore."

3

Which is a misconception about suicide? 1) Eight out of ten individuals who commit suicide give warnings about their intentions. 2) Most suicidal individuals are very ambivalent concerning their feelings about suicide. 3) Most individuals commit suicide by taking an overdose of drugs. 4) Initial mood improvement can precipitate suicide.

3

Which nursing diagnosis is correctly written? 1) Risk for social isolation R/T low self-esteem evidenced by staying in room during day. 2) Low self-esteem R/T major depressive disorder evidenced by childhood abuse. 3) Altered nutrition: less than body requirements R/T paranoia evidenced by 20-pound weight loss. 4) Conduct disorder R/T childhood sexual abuse evidenced by hostile and aggressive behaviors.

3

Which question would be most effective when evaluating the outcome of a crisis intervention? 1) "Has education helped you with positive behavioral changes?" 2) "Has crisis therapy precipitated maladaptive coping strategies?" 3) "Have you grown from the experience?" 4) "Why did you use maladaptive coping mechanisms to deal with this crisis?"

3

Which statement is correct concerning personality disorders? 1) Personality disorders generally emerge during adolescence. 2) Individuals diagnosed with personality disorders have insight into their disorder. 3) Personality disorders occur when personality traits become inflexible and maladaptive. 4) Individuals diagnosed with personality disorders demonstrate adaptive ability to perceive and relate to themselves and the environment.

3

Which statement most accurately describes the goal of anger management? 1) To specifically reduce the emotional feelings that anger engenders 2) To specifically reduce the physiological arousal that anger engenders 3) To reduce the emotional feelings and physiological arousal that anger engenders 4) To reduce the levels of neurotransmitters involved in anger expression

3

The nurse determines which is most essential when planning care for a client who is experiencing a crisis? 1) Focusing on emotional deficits 2) Encouraging lengthy explanations of the situation 3) Exploring previous coping strategies 4) Focusing on developmental issues that may have affected the client's ability to cope

3 Inquiring about previously successful coping strategies will provide insight as to how these strategies can be applied to the current crisis situation. The nurse can then plan care based on the knowledge of the client's past abilities to cope.

A nurse is conducting an assertiveness training class. Which of the following characteristics of assertive behavior should the nurse include? Select all that apply. 1) Eye contact should be steady and continuous. 2) Invasion of intimate space can be interpreted as assertive behavior. 3) While interacting, individuals should sit and lean slightly toward the other person. 4) Responses are most effective when they are spontaneous and immediate. 5) The facial expression is congruent with the verbal message.

3, 4, 5

Dan, a patient being treated for anxiety, tells the nurse at the mental health clinic that, in his perception, breathing exercises have never been beneficial. He asks the nurse what other options she might be able to assist him with to help him manage anxiety. Which of the following would be appropriate for the nurse generalist to offer as potential nursing interventions? Select all that apply. 1) Antianxiety agents 2) Biofeedback 3) Progressive muscle relaxation 4) Guided imagery 5) Meditation 6) Cognitive behavior therapy

3, 4, 5

Which of the following nursing interventions are appropriate when assisting a client during a crisis? Select all that apply. 1) Instill hope by using a future-oriented approach 2) Provide a private, low-stimulation environment 3) Discourage lengthy explanations of the situation 4) Compare the client's perceptions with those of the nurse 5) Guide the client through a problem-solving process

3, 4, 5 Feedback 1: The nurse should use a reality-oriented, not a future-oriented, approach. The focus of the problem should be on the present. Feedback 2: The nurse should stay with the client at all times during a crisis situation. Feedback 3: The nurse should discourage lengthy explanations or rationalizations of the situation, to promote an atmosphere for the verbalization of true feelings. Feedback 4: The nurse should compare the client's perceptions with those of the nurse to help clarify the current problem. Feedback 5: The nurse should guide the client through a problem-solving process to move the client in the direction of positive life change.

A physician writes discharge orders for a 30-day supply of imipramine (Tofranil) for a client who has a strong history of suicidal ideations. What is the priority nursing intervention? 1) Teach the client about side effects of antidepressants. 2) Direct the client to the hospital pharmacy to immediately fill the prescription. 3) Question the physician about the quantity of medication ordered. 4) Encourage the client to keep follow-up appointments.

3...As depression lifts, clients can become energized and able to implement suicide plans. The nurse should question the physician's order for a 30-day supply of Tofranil. Tricyclic antidepressant medications can be lethal in overdose. Early in treatment, quantities of these medications should be limited to no more than a 3-day supply with no refills.

In assessing a client diagnosed with borderline personality disorder, which characteristic would the nurse expect to observe? 1) Predictability 2) Controlled anger 3) Little tolerance for being alone 4) Stable and satisfactory relationships

3...Clients diagnosed with borderline personality disorder have little tolerance for being alone. They prefer a frantic search for companionship, no matter how unsatisfactory, rather than experiencing feelings of loneliness, emptiness, and boredom.

A nurse who is working in a correctional facility is about to conduct an initial assessment for an inmate convicted of pedophilia and now expressing suicidal ideation. Which of the following is the most important nursing task in the pre-interaction phase of relationship development with this client? 1) Establish an outline for the plan of care 2) Assess for suicide risk 3) Examine personal thoughts and feelings about working with someone who has sexually offended children 4) Evaluate the patient's accomplishment of established outcomes

3...It is most important in the pre-interaction phase that the nurse examine his or her thoughts and feelings about pedophilia and assess the ability to provide nonjudgmental care.

The nurse is counseling an actively suicidal client. What is the nurse's priority intervention? 1) Discuss strategies for the management of anxiety, anger, and frustration. 2) Provide opportunities for increasing the client's self-worth, morale, and control. 3) Place client on suicide precautions with one-on-one observation. 4) Explore experiences that affirm self-worth and self-efficacy.

3...Placing the client on suicide precautions with one-on-one observation provides a safe environment for an actively suicidal client. Maintaining client safety should always be a priority nursing intervention.

A client has a history of multiple somatic complaints involving several organ systems. Diagnostic studies revealed no physiological cause. Which diagnosis would the nurse expect the physician to assign this client? 1) Thought disorder 2) Bipolar disorder 3) Somatic symptom disorder 4) Depersonalization-derealization disorder

3...Somatic symptom disorder is characterized by multiple physical complaints with no organic cause. The state of being symptomatic is typically persistent for more than 6 months. Anxiety, depression, substance use, and addiction are common comorbidities with this disorder.

In developing a nursing care plan, the nurse compiles assessment data and then generates nursing diagnoses. Which statement is accurate as related to nursing diagnoses? 1) Nursing diagnoses are synonymous with DSM-5 diagnoses. 2) Nursing diagnoses identify medical treatment problems. 3) Nursing diagnoses document actual or potential functional client problems. 4) Nursing diagnoses are recognized and addressed by all health-related professions.

3...The basis for providing psychiatric nursing care is the recognition and identification of patterns of response to actual or potential psychiatric illnesses, mental health problems, and comorbid physical illnesses. Nursing diagnoses document actual or potential functional client problems.

The nurse is caring for a client who is considered a suicide risk. Which client statement would require immediate nursing intervention? 1) "I don't want to talk with the psychiatrist about my feelings." 2) "I've thought about killing myself, but I don't know how I'd do it." 3) "My family won't need to worry about me in another day." 4) "My wife took away all the medications from our medicine cabinet."

3...if theres a time frame that is most immediate!!

A client is discussing her suicide attempt with the nurse. Which nursing response is appropriate? 1) "Let's focus on the future instead of what already happened." 2) "Why did you try to kill yourself?" 3) "This is a sad topic. Let's talk about something more pleasant." 4) "Can you think of situations in which you have been in control?"

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A client threatens to kill himself, his wife, and their children if the wife follows through with divorce proceedings. During the pre-interaction phase of the nurse-client relationship, which action by the nurse is most appropriate? 1) Acknowledging the client's actions and encouraging alternative behaviors 2) Establishing rapport and developing treatment goals 3) Providing community resources on aggression management 4) Exploring personal thoughts and feelings that may adversely affect the provision of care

4

A client, diagnosed with major depression, is scheduled for electroconvulsive therapy (ECT) in the morning. After awakening, prior to the treatment, the client asks, "Can I please get something to eat?" Which is the appropriate nursing response? 1) "You may have something light, such as crackers." 2) "You'll need to ask the doctor. He'll be in shortly." 3) "Just don't eat anything containing tyramine, such as aged meats and yellow cheeses." 4) "I know you'd like breakfast, but eating before your treatment may lead to complications."

4

A native Japanese client, recently admitted to a nursing home, has difficulty communicating with the staff. In order to provide effective interventions, which knowledge should the nurse incorporate when planning client care? 1) Knowledge of cultural relativity 2) Knowledge of reminiscence therapy 3) Knowledge of resocialization 4) Knowledge of community resources for language translation

4

A nurse is teaching a client about meditation. Which client statement indicates a need for further teaching? 1) "The goal of meditation is mastery over attention." 2) "Meditation is useful to help control anxiety." 3) "Meditation can help my concentration improve." 4) "Only people who believe in God use meditation."

4

A nursing instructor is teaching about nursing interventions during electroconvulsive therapy (ECT). Which student statement indicates the need for further instruction? 1) "I have to ensure that the client's airway is patent and provide suctioning if needed." 2) "I have to observe and record the type and amount of seizure activity." 3) "I have to monitor vital signs and cardiac functioning, and time the seizure." 4) "I have to determine the electrode placement as either bilateral or unilateral."

4

A state's nurse practice act is an example of which type of law? 1) Common law derived from decisions made in previous cases 2) Criminal law used to protect the public welfare 3) Civil law used to protect private and property rights 4) Statutory law enacted by a legislative body

4

An angry client shouts at the nurse, "You red-headed skinny witch. You can't tell me what to do!" Which initial intervention should the nurse implement during this outburst? 1) Reprimand the client for poor judgment and derogatory remarks. 2) Respond to angry expressions with matching verbalizations. 3) Offer support by the use of empathy and therapeutic touch. 4) Ignore derogatory remarks.

4

In which phase of the nurse-client relationship do clients often experience feelings of sadness and loss related to their relationship with the nurse? 1) Pre-interaction phase 2) Orientation phase 3) Working phase 4) Termination phase

4

Jack is a recently divorced father of one child. He is the noncustodial parent. Which nursing response is therapeutic when Jack expresses sadness at not seeing his son as often as he'd like? 1) "I know just what you are going through. It will get better." 2) "Don't worry about it—your son will still love you." 3) "Why are you worried about this?" 4) "What concerns you most about this custodial arrangement?"

4

On the morning of a patient's first ECT procedure, the patient states, "I've been thinking about this all night and I've changed my mind; please call my doctor and tell her I don't want ECT treatments." Which of the following is the most appropriate response by the nurse? 1) "Since you have already signed the informed consent document, you will need to go through with the procedure." 2) "Don't worry; ECT treatments are not that bad." 3) "The team has already been assembled; it would be costly to back out now." 4) "I'll contact your doctor and let her know you are reconsidering."

4

Scott, who is in counseling for anger management, is meeting with his wife and the advanced practice nurse to discuss how anger issues have affected their relationship. The patient's wife states "I've tried to tell him for months now that it is not okay to get angry. You just have to find other ways to cope with things." Which response by the APN is the most accurate and empathic response? 1) "You're right; anger is a destructive emotion and always leads to bigger problems. Let's discuss some strategies for eliminating stressors that contribute to anger." 2) "A primary focus during counseling for anger management is learning how not to get angry. Your insight will be invaluable in helping Scott find other emotions to use in response to stressful situations." 3) "It sounds like Scott's aggression has been dangerous for you. How many times has Scott been physically abusive?" 4) "Anger is a normal, healthy emotion, but a person's behavioral response to anger can be problematic. Tell me more about how Scott's behavior, when he gets angry, has affected you."

4

The client has been on haloperidol (Haldol) for 3 days. He tells the nurse that his neck is stiff and his tongue is pulling to one side of his mouth. The nurse concludes that the client is experiencing: 1) Tardive dyskinesia 2) Acute panic level of anxiety 3) Akathisia 4) Acute dystonia

4

The nurse is caring for a 10-year-old client who has suddenly lashed out and is physically aggressive toward staff. What is the appropriate initial nursing action? 1) Encourage the client to talk openly and honestly. 2) Direct the client to express aggression by punching a bag. 3) Model appropriate communication techniques. 4) Mandate that clients in the milieu remain in rooms with doors closed.

4

The nurse is caring for a client who is displaying hostile behavior by slamming doors and responding sarcastically. Which nursing response best deals with this situation? 1) "It's fine to slam doors because this won't hurt anyone, but you'll have to guard your words." 2) "Slam that door one more time and you'll see how we deal with this situation." 3) "Why are you slamming doors and talking this way?" 4) "You seem out of control. Let's talk about what's making you so angry."

4

The nurse is preparing to help a client use mental imagery. Which nursing statement most accurately describes this process? 1) "As you focus on an object across the room, begin to breathe deeply." 2) "You must focus only on the ocean waves when performing mental imagery." 3) "Continue taking short, shallow breaths during the exercise." 4) "You may choose to focus on anything that makes you feel relaxed."

4

The nursing instructor is teaching a student about assessment of client self-esteem. Which statement would indicate that the student understands the difference between chronic low self-esteem versus situational low self-esteem? 1) "Situational low self-esteem is characterized by long-standing expressions of shame or guilt." 2) "Situational low self-esteem can stem from frequent job changes and lack of success in life." 3) "Chronic low self-esteem involves a current situational challenge to self worth." 4) "Chronic low self-esteem evolves from rejection of positive feedback."

4

What is the most important reason for nurses to explore their own culture as well as the culture of their clients? 1) To recognize that cultural customs and beliefs are resistant to change 2) To anticipate clients' dietary preferences and other personal care practices 3) To understand that cultures have little diversity within and among themselves 4) To understand and respond appropriately to diverse human behaviors

4

When a nurse is working with a client diagnosed with a somatic symptom disorder, which is the most appropriate nursing action? 1) Avoid discussing social and personal problems. 2) Focus on the physical symptoms. 3) Always meet the client's dependency needs. 4) Gradually minimize time spent focusing on physical symptoms.

4

Which characteristic does the nurse understand is central in somatic symptom disorders? 1) The presence of delusions 2) The presence of pain 3) The presence of paranoia 4) The presence of physical symptoms

4

Which charting entry is an example of the documentation of a subjective symptom? 1) "Temperature 101.4°F." 2) "No muscle rigidity or drooling noted." 3) "Client is hypervigilant and scanning environment." 4) "Client states, 'I'm seeing green men in my room.'"

4

While interviewing a client, a nurse asks, "Are you taking any herbal medicines or other over-the-counter supplements?" The client replies, "Sure, they are perfectly safe." Which nursing response is most appropriate? 1) "You know that's right!" 2) "The government regulates herbal medicines as pharmaceuticals." 3) "Those products are exceptionally safe." 4) "Herbal medications can be incompatible with prescription medications."

4

A woman who has been widowed recently is unable to cope with the tasks of daily living because a hurricane has completely destroyed her home. She is unable to identify any available family support. The nurse identifies that the client is experiencing which type of crisis? 1) Dispositional crisis 2) Life transitions crisis 3) Traumatic stress crisis 4) Maturational/developmental crisis

4 Crises resulting from traumatic stress are precipitated by unexpected external stressors over which the individual has little or no control and from which he or she feels emotionally overwhelmed and defeated. The natural disaster described in the question has precipitated a traumatic stress crisis.

An adolescent whose father was recently killed in a plane crash cries out, "No God would have let my father die like that! I don't believe in God anymore!" Which nursing statement is most appropriate? 1) "You shouldn't say things like that." 2) "Are you having any thoughts of wanting to harm yourself?" 3) "God has your father in a safe place right now." 4) "You're feeling angry. Let's sit together and talk about what's happened."

4 The nurse is using the therapeutic techniques of making observations and offering self. This will help build trust and establish the foundation for a working relationship, while recognizing and accepting the client's feelings in a nonjudgmental manner.

An athlete has been recently diagnosed with diabetes but denies the diagnosis. The athlete states in a monotone, "I'm ready to end my life." Which would be the priority outcome of crisis intervention for this client? 1) The client will participate in unit activities. 2) The client will express the desire for continued therapy by day three. 3) The client will list five personal strengths by day two. 4) The client will remain safe during hospitalization.

4 The priority outcome for a suicidal client is that the client remains safe. All other outcomes are inconsequential if the client commits suicide.

Walter, a patient diagnosed with antisocial personality disorder, was witnessed taking illicit drugs on the psychiatric unit, in direct violation of unit policy and law. It is his first offense. Which of the following nurse behaviors are appropriate in response to the client's behavior? Select all that apply. 1) Instruct the patient that the next time he violates policy there will be consequences. 2) Inform the patient that the consequence of violating policy is that he will be forced to forfeit his dinner for that evening. 3) Take the patient to a locked seclusion room for a minimum of one hour. 4) Inform the patient that as a consequence the police will be notified. 5) Conduct a room search for evidence of other illicit drugs.

4, 5

A suicidal client diagnosed with borderline personality disorder exhibits both fear and anger during the intake interview. Which nursing intervention would be appropriate for this client? 1) Confine the client to a single room to promote calm and decrease fear and anger. 2) Medicate client with antipsychotic medication to decrease fear and anger. 3) Within 7 days, client will verbalize strategies to interrupt escalation of fear and anger. 4) Start supportive counseling to identify sources of anger.

4...A client diagnosed with a borderline personality disorder often displaces negative feelings onto the staff, resulting in countertransference and splitting. Countertransference refers to the nurse's emotional and behavioral response to the client. Splitting is the client's inability to accept both positive and negative feelings about others, viewing them as all good or all bad. Identifying the client's source of anger through supportive counseling may help decrease splitting, countertransference, and any resulting conflict

A client is experiencing a crisis. The client states, "I can no longer function." The nurse directs the client to a quiet environment, but the client does not respond to the instruction. How would the nurse interpret this client's behavior? 1) The client is experiencing a physical disorder. 2) The client is suicidal. 3) The client is experiencing episodic catatonia. 4) The client is experiencing a decrease in perceptual fields.

4...A decrease in perceptual fields is a symptom of severe anxiety, which can occur during crisis. This client is not able to "hear" or "follow" the directions provided by the nurse, which indicates a decrease in perceptual fields.

A client with a history of a suicide attempt has been discharged and is being followed in an outpatient clinic. At this time, which is the most appropriate nursing intervention for this client? 1) Provide the client with a safe and structured environment. 2) Isolate the client from all stressful situations that may precipitate a suicide attempt. 3) Observe the client continuously to prevent self-harm. 4) Assist the client to develop more effective coping mechanisms.

4...Assisting the client to develop more effective coping mechanisms is a nursing intervention that can and should be implemented in outpatient settings as ongoing follow-up.

A client diagnosed with generalized anxiety disorder complains to the nurse that he only gets about four hours of sleep because as soon as he gets into bed, he starts thinking of things that upset him. Which of the following nurse responses is an example of formulating a plan of action? 1) "What time do you usually go to bed?" 2) "Tell me more about the things that upset you." 3) "I notice you become tearful whenever we talk about this." 4) "What could you do prior to going to bed that might promote relaxation?"

4...By encouraging the client to begin thinking about how to problem-solve, the nurse is assisting the patient to formulate a plan of action.

A client diagnosed with borderline personality disorder is admitted to a psychiatric unit. Which behavior pattern would the nurse expect to observe? 1) Social isolation 2) Suspicion of others 3) Bizarre speech patterns 4) Generating conflict among the staff

4...Clients diagnosed with borderline personality disorder, having little empathy toward others, are unable to accept both positive and negative feelings and view others as all good or all bad. They tend to split staff, generating conflict.

According to psychodynamic theory, which primary defense mechanism would the nurse expect to find in an amnesic client? 1) Suppression 2) Sublimation 3) Displacement 4) Repression

4...Repression, which is the involuntary blocking of unpleasant feelings and experiences from one's awareness, is the defense mechanism most often used by clients experiencing amnesia. Freud believed that dissociative behaviors, including amnesia, occurred when individuals repressed distressing mental contents from conscious awareness. He believed that this mechanism protected them from emotional pain.

When assessing suicidal risk, which nursing question is most appropriate? 1) "Can you tell me about your lifestyle?" 2) "You say that you won't be around much longer. Can you tell me what that means?" 3) "Have you written any suicide notes?" 4) "You seem desperate. Do you have a plan and a method for ending your life?"

4...The nurse makes an observation related to potential suicidal ideations and questions the client about a plan and a means to carry out the plan. This is the most appropriate question to provide the nurse with the most complete information that will help determine the client's suicide risk.

A client has been diagnosed with major depressive disorder. The psychiatrist prescribes imipramine (Tofranil). What client teaching regarding this medication should the nurse include? 1) The medication may cause dry mouth. 2) The medication may cause nausea. 3) The medication should not be discontinued abruptly. 4) The medication may cause photosensitivity. 5) All of the above.

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