Psychopathology Test 4 - Evolve

Grace wants to find out more about the Potter family and tells them she will do a genogram. Rhea asks what a genogram is. The best response would be: "A genogram will assess risk for mental illness in future generations." "A genogram is a tool used for deciding on the best type of therapy for your family." "A genogram will help me see your family structure, history, and current functioning." "A genogram will help us determine the cause of Jeremy's schizophrenia."

"A genogram will help me see your family structure, history, and current functioning." By creating a genogram, nurses and therapists are able to map the family structure and record family information that reflects both history and current functioning. The other options do not describe the function of a genogram.

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

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

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

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

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

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

A client says to the nurse, "I am going to stop taking these antidepressants and start using herbs. After all, they..." The client will probably complete the statement with the reason that herbal preparations cost less. produce a faster cure. have no side effects. are recommended by folk healers.

cost less. Although not inexpensive, herbal preparations are often less expensive than prescription medication, especially a newer medication still under patent.

A nurse is asked by a client about the basis for the use of alternative and complementary therapies. The best reply would incorporate the information that alternative and complementary therapies are based on research-based findings. cultural and historical experience. consumer satisfaction with the conventional Western healing system. consumer dissatisfaction with conventional Western healing methods.

cultural and historical experience. Culture and long experience with certain remedies are the basis for many alternative and complementary therapies.

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

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

When the group leader suggests that a client "choose the problem that is troubling you most at this time and tell us about it." The leader is promoting insight. focusing. reframing. feedback.

focusing. Focusing helps the group consider one problem rather than trying to attend to multiple problems at one time.

During a family therapy session a wife states, "My husband is always angry.The children and I are always on edge. We can never relax." The nurse identifies the wife's communication technique as placating. distracting. generalizing. manipulating.

generalizing. Generalization involves making global statements using "always" and "never" when dealing with problematic family issues. Generalization allows the speaker to avoid dealing with specific examples.

A highly useful tool to uncover multigenerational issues in a family is the genogram. focused interview. family function checklist. family assessment device.

genogram. A genogram maps family structure and family information for at least three generations. It graphically depicts relational patterns and multigenerational issues. Demographics, sociocultural context, and critical events can be noted.

A client tells the nurse, "My memory was getting worse. The health foods store gave me this bottle of pills and said my memory should improve in a month or so." The nurse can expect that the remedy given to the client contains gingko biloba. camomile. valerian. kava.

gingko biloba. Gingko biloba has been used for the treatment of mild cognitive impairment with some success.

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

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

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

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

A client has been diagnosed with acute anxiety attacks. Which herbal remedy should the nurse caution the client to avoid? Gingko biloba Lemon balm Serotonin Kava

Kava Kava has significant analgesic and anesthetic properties. Kava may potentiate the effects of benzodiazepines and other central nervous system depressants such as alcohol. The FDA issued a consumer advisory based on the potential risk for liver failure.

Care that places the patient at the center of care, focuses on prevention and wellness, and attends to the patient's physical, mental, and spiritual needs is referred to as: orthodox. integrative. allopathic. mainstream.

integrative. Integrative care is holistic and focuses on the patient and on prevention and wellness. The other options all refer to conventional health care systems in the United States.

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

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

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

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

The client at the alcohol treatment center tells his outpatient group, "I went to an oriental medicine place to see if they could do something to help me stay away from alcohol. I ended up with tiny silver rods placed in various spots in my body. They twirled the rods, then removed them. So far I haven't had any cravings since I went there several days ago." The client is describing allopathy. acupuncture. naturopathy. chiropractic manipulation.

acupuncture. Acupuncture is a Chinese remedy that involves insertion of tiny needles through the skin. The rationale for the use of acupuncture is to restore the balance of the body's energy (chi).

A client asks which herbal tea would be good to drink at bedtime. The best answer would be green tea. black tea. chamomile tea. peppermint tea.

chamomile tea. Chamomile tea has been studied and found to have relaxing properties.

The nurse leader of a cognitive therapy group for persons with dysphasia would use the technique of negative reinforcement. conflict suppression. clarification. flooding to desensitize a client to anxiety.

clarification. Clarification is a statement or question to check the meaning of an interaction. Its purpose is to improve group communication by decreasing misunderstandings

The family function that helps define the roles of family members and allows for differences among members is communication. management. clarity. socialization

clarity. Clear boundaries maintain a distinction among individuals in the family.

A nurse is the leader for a medication group for clients diagnosed with bipolar disorder. No new clients will be added as the group progresses, and so the group is considered open. homogeneous. heterogeneous closed.

closed. A closed group admits no new members.

A key quality indicator that might be identified for successful outcome in a medication education group could be that clients will state they liked the leader. demonstrate a bond among members of the group. describe modes of transmission of sexually transmitted diseases. confer with health care provider before changing medication regimen.

confer with health care provider before changing medication regimen. The key quality indicator that relates to successful outcomes in a medication education group is the client's recognition of the need to discuss medication changes with his or her physician rather than adjusting the dose or stopping the medication without consultation.

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

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

When the nurse wishes to obtain assessment data about possible use of complementary substances, which query would have the best potential to yield accurate information? "You are taking only the medicines the doctor prescribed and in the amounts prescribed, correct?" "Tell me how you take the medicines the doctor prescribed for you." "Tell me every pill and supplement you take regularly." "What things do you do for yourself to improve your health?"

"Tell me every pill and supplement you take regularly." The nurse needs to spell out the information needed rather than leaving up to the client what to report.

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

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

Noelle is a patient on the psychiatric unit. She is scheduled to start group therapy today. She asks you, "What does group work mean? My provider said I would be going to group and doing group work." Your best response is: "You will attend group therapy and find solutions for each other's problems." "You will give and receive feedback from a group of your peers who may also have similar problems to work through." "You will share your issues with the group and then split up to work separately on solutions based on the ideas the other members provide." "Group work is the work that you do beforehand so you can present it to the group when you meet."

"You will give and receive feedback from a group of your peers who may also have similar problems to work through." Group work is a method whereby individuals with a common purpose come together and benefit by mutually giving and receiving feedback within the dynamic and unique group context. The other options do not describe group work.

A strategy the group leader may use to encourage a nonparticipating member to speak during a session is share with the client that "you are letting the group down when you fail to contribute." "your opinions about what just happened is important." "you must be feeling safe enough to enter the discussion by now." "what you are thinking is very important to the group."

"what you are thinking is very important to the group." Options A, B, and C place the client on the defensive and encourage further withdrawal. Option D is less threatening. The leader needs to be patient and, in a nonthreatening manner, encourage members to make contributions.

Which family situation should the nurse assess as warranting a referral for family therapy? A couple are having their first child. They say, "It's certainly going to be a change for us." A husband and wife are sending a son off to college and planning their daughter's wedding. They say, "Soon we will be back to having an empty nest again." A couple are having difficulty dealing with the erratic behavior of their bipolar son. They say, "We're at the end of our rope." The parents of a blended family with five children ranging in age from 5 to 15 years say, "It's never quiet, but the disagreements eventually get worked out."

A couple are having difficulty dealing with the erratic behavior of their bipolar son. They say, "We're at the end of our rope." The family in option C is the only family system clearly expressing an unmanageable degree of stress. The other systems may be undergoing stress but have not expressed distress.

Which situation is the best example of a double bind? A wife sighs while telling her husband, "You can go out with the boys tonight if it's what you really want to do." A mother tells her son, "Under no circumstances will I give you permission to stay out after midnight." A roommate states, "I would prefer to have you call if you think you are going to be late for dinner." A man says, "I was surprised and delighted when my entry was chosen for an award."

A wife sighs while telling her husband, "You can go out with the boys tonight if it's what you really want to do." A double bind is created when the verbal and nonverbal messages are incongruent, leaving the listener confused or trapped ("damned if he does and damned if he doesn't").

At what point in the life of a group lasting 12 sessions should confidentiality be explained and discussed? At the first session As the working phase begins Just before the group terminates At the time each client is interviewed

At the first session Confidentiality is part of the ground rules that are established at the beginning of the group sessions.

Which alternative andcomplementary treatment modality involves the use of essential oils to release neurotransmitters in the brain? Orthomolecular therapy Acupuncture Hypnosis Aromatherapy

Aromatherapy Aromatherapy, the use of essential oils for inhalation, works to activate the body's healing energy to balance the mind, body, and spirit. Essential oils stimulate the release of neurotransmitters in the brain.

Which supplement could be recommended for Elaina's complaints of hot flashes? Kava St. John's wort Gingko biloba Black cohosh

Black cohosh Black cohosh is an extract from a root that was used for centuries by Native Americans to ease pain associated with rheumatism, sore throat, and menstrual discomfort. It continues to be popular as a way of decreasing hot flashes and as an alternative to hormone replacement therapy for women in menopause. The other options are not used for relief of hot flashes.

A family consists of a husband, a wife, their three children, and the wife's mother. This family form is called a(n) extended family. dyadic family. blended family. indwelling family.

extended family. An extended family (multigenerational) is a composite of three or more generations.

How should the nurse counsel a client who plans to use CAM to treat relapse of schizophrenia with regard to efficacy and cost? "The cost of CAM is usually higher than the cost of contemporary Western medical treatment, and its efficacy is lower." CAM is usually lower than contemporary Western medical treatment, and its efficacy is higher." CAM and contemporary Western medical treatment are nearly equal, and outcomes are essentially the same." CAM may be lower, but its efficacy of treatment cannot be assured."

CAM may be lower, but its efficacy of treatment cannot be assured." Clients must be informed that the efficacy of treatment with CAM has not been researched. At this point contemporary Western treatment methods offer the greatest hope of reducing symptoms of schizophrenia.

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

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

A nurse is asked to explain the difference between alternative and complementary therapy. The best answer is Complementary therapy is used in conjunction with conventional Western remedies, whereas alternative therapies replace conventional Western remedies. Complementary therapy replaces conventional Western remedies, whereas alternative therapies are used in conjunction with conventional Western remedies. Complementary therapy is based on Eastern medicine, whereas alternative therapy has no medical basis. Complementary therapy is curative, whereas alternative therapy is palliative.

Complementary therapy is used in conjunction with conventional Western remedies, whereas alternative therapies replace conventional Western remedies. Alternative therapies are used alone or with other alternative therapies. Complementary therapies are used in tandem with conventional treatments.

What is the group leader's responsibility in the termination phase? Allowing members to exchange contact information so they may remain as a support for each other Removing himself or herself from the group so they can function independently Encouraging group members to reflect on progress made Encouraging group members to fill out evaluation forms so the group leader can further improve his or her therapeutic technique

Encouraging group members to reflect on progress made In the termination phase, the group leader's role is to encourage members to reflect on progress they have made and identify posttermination goals. Contact with other members in the group outside of the group is not therapeutic and is usually discouraged. The group leader does not remove himself or herself from the group process. Group members do not fill out evaluation forms in group therapy.

Advantages of groups include: (select all that apply): Feedback from peers Treatment of multiple people at one time Promotion of independence in problem solving Provision of an opportunity to practice communication Promotion of a feeling of belonging Promotion of confidentiality

Feedback from peers Treatment of multiple people at one time Provision of an opportunity to practice communication Promotion of a feeling of belonging All these options are advantages of groups. The other options are not advantages of group therapy.

Which technique would be least helpful in putting family members at ease as family therapy begins? Getting each member's view of the way the problem affects the family Focusing on the identified patient's views about the family problems Providing clear, understandable information to the family members Maintaining a neutral, nonjudgmental demeanor as members speak

Focusing on the identified patient's views about the family problems The problems of the identified patient will not be the focus of the sessions. The presenting problem will be viewed in terms of circular causality, and the family system's anxiety will be addressed.

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

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

The nurse cautions a client about the fact that, when using herbal preparations, the client does not know the actual dose being ingested. What is the basis for this caution? No manufacturing standardization exists. Clients are unreliable resources of medication information. Pure drug is cut with impure substances before going on sale in stores. Underdosage leads to poor results from herbal supplements.

No manufacturing standardization exists. Currently a lack of standardization and regulation of herbal products exists; thus, the individual never knows exactly what is being ingested. This is dangerous because these substances are neither benign nor without potential for drug-drug interactions.

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

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

At what phase of group development would the nurse hear the following interchange? Client 1: "I do not feel comfortable here." Client 2: "I wonder what we are supposed to talk about." Client 3: "Let's ask the leader to explain things again." Preorientation Orientation Working Termination

Orientation During orientation the members get to know one another. Initially, they experience anxiety and are unsure of the expectations.

Grace is the nurse working with the Potter family, which consists of married parents Todd and Rhea, 16-year-old Jasmine, and 19-year-old Jeremy, who has recently been diagnosed with schizophrenia. The rest of the family is bewildered with Jeremy's symptoms and express that they feel lost in knowing how to deal with things. Which of the following approaches to family therapy would Grace take at this time to provide support and give information to the family that will help them cope with Jeremy's illness? Insight-oriented family therapy Psychoeducational family therapy Behavioral family therapy Multigenerational family therapy

Psychoeducational family therapy The primary goal of psychoeducational family therapy is the sharing of mental health care information. This helps family members better understand their member's illness, prodromal symptoms (symptoms that may appear before a full relapse), medications needed to help reduce the symptoms, and more. Psychoeducational family meetings allow feelings to be shared and strategies for dealing with these feelings to be developed. Insight-oriented therapy focuses on developing increased self-awareness, other awareness, and family awareness among family members. Behavioral family therapy focuses on changing behaviors of family members to influence overall patterns of family interactions. The last option is a distractor and incorrect.

Savannah is a patient with borderline personality disorder who is attending a court-ordered therapy group. She projects an angry affect. She doesn't speak much, but when she does it is usually to make a snide comment about another member of the group or the group's leader. What is the best way for the leader to handle this? Remove Savannah from the group because she is disrupting the group process for other participants. Respond neutrally to Savannah's comments, ask for group feedback, and talk to her privately to form a connection. Spend one entire group session focused on Savannah and try to get her to open up to other members in depth. Confront Savannah firmly each time she makes a rude comment and let her know she will be taken out of group if she continues.

Respond neutrally to Savannah's comments, ask for group feedback, and talk to her privately to form a connection. The group leader should listen to the comments objectively and without becoming defensive. The leader may choose to speak to the group member in private and ask what is causing the anger, to form a connection with the patient that may result in less disruptive behavior in group. In the group setting, the leader can focus on positive group members whose comments may reduce the hostility of the negative group member. Part of the group process includes problem-solving skills and getting group feedback for issues. Spending an entire session discussing one patient is inappropriate in a group setting. Confrontation done on a continual basis would disrupt the group process and focus heavily on the hostile client.

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

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

A client tells the nurse he has been taking St. John's wort. On the basis of this information, the nurse should gather additional assessment data about feelings of depression. his experience of hallucinations. fears of common objects or situations. the urge to consume excessive amounts of alcohol.

feelings of depression. St. John's wort is primarily used by individuals to elevate a depressed mood.

Which of the following is a herb commonly used to treat mild depression? Buspirone Valerian St. John's wort Gingko biloba

St. John's wort St. John's wort is used for the treatment of mild to moderate depression.

The family consists of the husband and his wife, their four children, the wife's 21-year-old sister, and client's elderly aunt. Which members are considered the client's nuclear family? The parents and their four children The wife and her sister The husband and his aunt The four children and the wife's sister

The parents and their four children The term nuclear family refers to parents and the children under the parents' care.

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

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

At what point would the nurse expect a family to demonstrate the greatest dislocation in the family life cycle? When the couple is deciding whether to have children When the first child enters school When a member is diagnosed with multiple sclerosis When the couple renegotiates the marital system as a dyad

When a member is diagnosed with multiple sclerosis Family stress is often the greatest at times of serious illness, death, or divorce.

A democratic group leadership style is most appropriate for a group that meets for 30 minutes to discuss unit rules. a group that is focused on creating meaningful trauma-related artwork. a psychotherapy group directed toward anger management. a group that is responsible for organizing the unit's holiday celebration.

a psychotherapy group directed toward anger management. Democratic leadership is best implemented when extensive group interaction is devoted to problem solving.

A chiropractic practitioner will explain to clients that chiropractic treatments are effective because adjustments put the spinal column in a normal position allowing improved energy flow. manipulation of soft tissue reduces muscle spasm and produces relaxation. the laying on of hands reduces stress and produces relaxation. needle placement modulates the flow of energy along body meridians.

adjustments put the spinal column in a normal position allowing improved energy flow. Chiropractic is based on the theory that energy flows from the brain to all parts of the body through the spinal cord and spinal nerves. Manipulation of the spinal column puts the vertebrae back into normal position to allow the proper flow.

When a group member notices another member crying and suggests, "It looks as though you need the floor to tell us what is so upsetting to you." the behavior being demonstrated is reality testing. universality. ventilation. altruism.

altruism. Altruism involves putting another's needs before one's own.

When a group member supports and encourages another group member and feels "good" about doing so, the group phenomenon at work is altruism. ventilation. universality. group acceptance.

altruism. Altruism involves putting another's needs before one's own.

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

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

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

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

When a member tells the group, "I think the committee saw how unsure of myself I am. I felt all shaky inside during the promotion interview, just like I am feeling and acting right now." To present reality the leader should remain silent and nod slightly to signal that the client should continue. say, " Tell us more about how you are feeling." ask, "Does this shaky feeling occur often?" ask the group to give feedback about how the client appears to them.

ask the group to give feedback about how the client appears to them. This option is the only one that will result in present reality. The client will learn more about the reality of how he appears to others. Option A gives encouragement to continue. Options B and C seek additional information.

A function of the entry-level staff nurse in caring for families is to assess the amount of stress on the system. conduct private family therapy sessions. prescribe psychobiological intervention. determine the new skills the family needs.

assess the amount of stress on the system. An important function of entry-level staff nurses is to assess cues from various family members that indicate the degree and amount of stress the family system is experiencing and report these so that appropriate interventions may be made in a timely manner by a qualified counselor.

A 26-year-old client diagnosed with schizophrenia is having difficulty adjusting to his return to the community after hospitalization. His family is dismayed by his poor hygiene and avolition. A useful strategy for the nurse to suggest would be for family members to attend a psychoeducational group. closely supervise the client on a daily basis. learn to ignore all symptoms except delusions. take turns monitoring the client to avoid burnout.

attend a psychoeducational group. Psychoeducation can help the family learn to accept the illness of a family member, learn to deal effectively with symptoms, and understand medications.

At the first family therapy session the family tells the therapist that "We wouldn't have to be here if our younger son wasn't such a brat. He seems so different from our other son. We never had difficulty with him misbehaving." The other sibling offers "He gets upset pretty easily." The nurse should suspect that the younger son is being scapegoated. resisting boundaries. assuming the family management function. experiencing multigenerational transition.

being scapegoated. A scapegoat is the person others blame for the family's distress. Those blaming the scapegoat are usually trying to keep the focus off their own painful issues and problems. The parents seem to be scapegoating the younger son.

The nurse who assesses a family as having enmeshed boundaries includes the care plan goal of "Family members will define individual beliefs and needs." form triangles to reduce anxiety." develop greater comfort with enmeshment." increase intrafamilial relational conflicts."

define individual beliefs and needs." Enmeshment occurs as the result of the blending of individuals so that distinct persons fail to emerge. A strategy would be to promote individuation resulting in each person being able to emerge as a distinct entity.

During a family therapy session the mother says to her daughter, "I would like to know why you took the piece of pie that was left after dinner last night. You knew I wanted it." Later the father tells his daughter, "I know exactly why you did that." The nurse therapist should consider the possibility that the family has clear boundaries. diffuse boundaries. disengaged boundaries. no boundary problems.

diffuse boundaries. A common phenomenon within families with diffuse boundaries is that individuals expect other members of the family to know what they are thinking.

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

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

Marnie is the nurse working with a family whose boundaries are not clear and whose members are overinvolved with each other. The term that describes this type of family dynamic is: clear boundaries. enmeshment. scapegoating. rigid boundaries.

enmeshment. When boundaries are diffuse, individuals tend to become "enmeshed." As a consequence, it is not clear who is in charge, who is responsible for decisions, and who has permission to act or take charge; family members are often overinvolved with each other. Clear boundaries are adaptive and healthy. They are well understood by all members of the family and give family members a sense of "I-ness" and also "we-ness." Scapegoating refers to a situation in which one member of the family is seen as the cause of all the problems. Rigid boundaries are characterized by the consistent adherence to rules and roles—some apparent and some less so—no matter what.

Elaina, a 53-year-old patient with a pacemaker and history of cerebrovascular accident (stroke) for which she takes Coumadin, comes to see her provider at the office where you work. She tells you she "feels so much better" now that she is taking ginseng to relieve her menopausal symptoms. Your best response is based on the knowledge that: ginseng is an appropriate herbal supplement for Elaina to use. ginseng has no effect on menopausal symptoms. ginseng has anticoagulation effects. ginseng is implicated in strokes.

ginseng has anticoagulation effects. Ginseng has anticoagulant effects. Drinking ginseng tea may increase the effects of prescription anticoagulants, and the consequences could seriously affect blood clotting. The other options are untrue.

The members of a family openly tell each other what they are thinking and feeling. A nurse listening to their interchanges would assess them as using generalizing communication. double-bind communication. disengaged communication. healthy communication.

healthy communication. Healthy communication is exemplified by being clear and direct in saying what you want and need.

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

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

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

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

The nurse giving information about alternative and complementary therapies would best describe them as disease specific. homeopathic. quackery. holistic.

holistic. Many alternative and complementary therapies are holistic in nature, often addressing prevention of disease or healing of the whole person; conventional Western medical remedies tend to be disease or symptom specific.

Using a minute amount of a substance that produces the same symptom as the client's chief symptom, so as to stimulate the body's immune system, is the rationale for use of the remedies prescribed in allopathy. homeopathy. naturopathy. orthomolecular therapy.

homeopathy. Homeopathy attempts to stimulate the body's immune system to relieve the client's distress. Tiny amounts of substances known to produce the symptoms the client is experiencing are used to achieve this.

A nurse is asked to give an example of an alternative medical system; the best example is psychotropic medication. chi adjustment. homeopathy. allopathy.

homeopathy. Homeopathy is listed as one of the five major domains of complementary and alternative health care by the National Center for Complementary and Alternative Medicine. Other examples are oriental medicine and naturopathy.

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

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

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

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

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

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

Risks of using complementary and alternative medicine (CAM) therapies include: (select all that apply): lack of standards or regulations that ensure safety for herbal products. not informing health care providers of the use of CAM. interactions between CAM products and prescribed medication. delayed treatment while experimenting with alternative treatments. not knowing how much of an ingredient is in supplements because of nonregulation.

lack of standards or regulations that ensure safety for herbal products. not informing health care providers of the use of CAM. interactions between CAM products and prescribed medication. delayed treatment while experimenting with alternative treatments. not knowing how much of an ingredient is in supplements because of nonregulation. All these options describe risks of using complementary and alternative medicine and therapies.

Blaine is an advanced practice nurse running a group on the adolescent unit. The patients are talking about their favorite music and artists. Blaine makes no attempt to control the topic or the member's behavior and makes no comment unless he is asked a direct question. Blaine's leadership style is: autocratic. authoritarian. democratic. laissez-faire.

laissez-faire. A laissez-faire leader allows the group members to behave in any way they choose and does not attempt to control the direction of the group. Autocratic leaders control the group, pick the topic, and don't allow for much interaction. Authoritarian is another word for autocratic. A democratic leader involves the group members in decision making.

A girl is overheard saying to her brother, "If you stick up for me with mom and dad, I will forget I heard you planning to sneak out after they are asleep." This can be assessed as a type of communication called manipulative. scapegoating. generalizing. placating.

manipulative. One example of manipulation occurs when a family member makes a request with strings attached so that the other person has difficulty refusing.

A treatment group that a novice psychiatric nurse is likely to be assigned to lead is group psychotherapy. medication education. dialectical behavior treatment . art therapy group.

medication education. Medication education groups are led by basic-level registered nurses, because the knowledge of medication action, administration, and possible side effects are within the scope of RN practice.

The client, who is the eldest son in a family in which the father was an alcoholic and the mother was an enabler, drinks heavily and has married a woman who never complains about his drinking. This scenario suggests a double bind. sociocultural issue. multigenerational issue. stage in the family life cycle.

multigenerational issue. Multigenerational issues refer to patterns that are passed down through generations.

The nurse reading a group protocol notes that it is a closed group and understands that discussion topics will be restricted. membership is limited to one gender. no new members will be allowed. the group is demonstrating cohesiveness.

no new members will be allowed. A closed group is one to which no members are added once the group has begun.

The family that consists of a married mother and father and three biological children all living together is referred to as a(n): blended family. cohabitating family. nuclear family. other.

nuclear family. A nuclear family consists of one or more children who live with married parents who are the biological or adoptive parents to all the children. Blended family refers to one or more children living with a biological or adoptive parent and an unrelated stepparent who are married to each other. Cohabitating family refers to one or more children living with a biological or adoptive parent and an unrelated adult who are cohabitating. "Other" refers to one or more children living with related or unrelated adults who are not biological or adoptive parents. This includes children living with grandparents and foster families.

The complementary and alternative medicine (CAM) practitioner is asked by a client why aromatherapy makes her feel more relaxed and healthy. The practitioner's answer will be that the basis for aromatherapy is manipulation of soft tissue to produce relaxation. olfactory nerve stimulation to send messages to the limbic system. stimulation of spinal nerves to relieve pain and increase energy. rerouting of energy flow throughout the body to provide balance.

olfactory nerve stimulation to send messages to the limbic system. The limbic area is the seat of memory, learning, and emotion. Associating the aroma with pleasant events may bring comfort, warmth, and a feeling of security.

The phase most influenced and managed by the group leader is orientation. working. termination. post-termination.

orientation. The group leader often is most directive in the orientation phase, in which roles and ground rules are set.

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

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

Self-help and support groups are least influenced by the premise that professional leadership is inappropriately expensive for treatment of minor problems. people who have had a particular problem can help others with the same problem. promotion of dialogue, self-disclosure, and encouragement can produce change in members. self-help and support groups are designed to serve people with a common problem.

professional leadership is inappropriately expensive for treatment of minor problems. Self-help and support groups do not exist to address minor problems. Problems successfully treated by self-help and support groups include addictions, eating disorders, and adjustment to life changes caused by major illnesses.

The group goals are to learn to express feelings comfortably rather than keep them covert. When a group member shares with the group how expressing these feelings makes her feel, she is engaging in group content. confrontation. subgrouping. providing feedback.

providing feedback. Feedback includes letting the group know how they and the comments made in group make the individual feel.

During family therapy the family's youngest daughter says, "They care more about my sister because she's older and gets straight As in school." The nursing diagnosis with priority focuses on deficient knowledge. parental role conflict. defensive coping. relational problems.

relational problems. This discourse concerns relational problems related to a mental disorder, a generic medical condition, or a sibling relational problem. No data suggest the other diagnoses.

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

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

When several group members always sit together and nod or smirk as others are talking, the leader assesses this behavior as altruistic. universality. subgrouping. contingency seeking.

subgrouping. Subgrouping involves formation of a splinter group within the larger group. Members of the subgroup show more loyalty to each other than to the larger group.

When a client is encouraged to talk with others who have had similar problems, the nurse is suggesting a cognitive-behavioral group. time-limited group. support group. milieu group.

support group. Support groups are composed of members who have had or are currently sharing similar experiences, such as a bereavement group or a group of women with breast cancer.

The phase of group therapy in which the group deals with feelings associated with separation and loss is orientation. working. termination. post-termination.

termination. During termination, the group members must face the fact that they are at a parting of the ways. Unresolved feelings associated with other terminations and separations may surface and need to be addressed.

Shannon tells you that she is nearing the end of a medication trial where she is taking a pill that may improve her symptoms of gastroesophageal reflux disease. She states, "I found out that I was in the section of the study not actually taking the medicine. I don't understand that, because all my symptoms improved!" You realize she may be experiencing: the placebo effect. an unethical research study. optimistic recovery. depression.

the placebo effect. The placebo effect refers to a treatment that actually does nothing, even though the condition for which it is used improves in response to its use. A study of this type is an ethical research study and the participants sign informed consent. There is nothing to indicate depression.

The client tells the nurse, "The CAM practitioner asked me to try to relax my mind and let go of my pain. She then passed her hands over me, beginning at my head and working down to my feet, never actually making physical contact with any part of my body. She told me that when the pain begins to bother me, I can relax and let the pain go." The client is describing therapeutic touch. acupuncture. orthomolecular therapy. eye movement desensitization reprocessing.

therapeutic touch. Practitioners of healing touch believe healing is promoted when the body's energies are in balance. Practitioners assess the energy field and clear and balance it through hand movements or direct energy in a specific region of the body. The therapist does not physically touch the client. After a session of therapeutic touch, many clients express a sense of deep relaxation.

An important means of promoting good self-esteem in children is for the mother to assume the role of placator to avoid family confrontations. to tightly define roles and establish individual responsibility for most functions. to establish closed boundaries to provide structure. to communicate validation of individual worth.

to communicate validation of individual worth. Self-esteem develops when an individual is made to feel good about oneself and one's role in the family. Parents should offer praise when a child has done well. They should discipline the child without making one feel bad about oneself; rather, they should help one recognize that the action was wrong, not that one is bad.

A client asks the nurse, "Why hasn't any research been done to substantiate the curative effect of homeopathic remedies?" The nurse should reply, "Research on homeopathic remedies is difficult because treatment is individualized, and several clients with the same symptom might receive different treatments." practitioners are reluctant to reveal what substances they use to treat the various symptoms." many of the remedies are poisons, and the ethical guidelines for research would prohibit their use." clients are embarrassed when found to be using homeopathy and refuse to participate in research."

treatment is individualized, and several clients with the same symptom might receive different treatments." No standard protocols are used in homeopathy. All treatment is highly individualized, making research next to impossible

The client disagrees that her husband should seek a promotion since it will require the family to move. After she discusses the situation with their 12-year-old, the child tells her father she doesn't want to move. The client has engaged in triangulation. enmeshment. a double bind. diffuse boundaries.

triangulation. Triangulation occurs when a two-person relationship is under stress and one person draws in a third person to stabilize the system by forming a coalition.

As Grace continues to work with the family, Rhea confides that she and her husband Todd have not been getting along well. She states that daughter Jasmine provides much support to her, and that Jasmine "doesn't really like her dad much anymore and doesn't talk to him." Grace suspects: emotional abuse. neglect. boundary blurring. triangulation.

triangulation. Triangulation refers to a family "triangle" of three. When the tension in a dyad (two people) builds, a third person (child, friend, or parent) may be brought in by one of the members. This third person of the dyad serves to help lower the tension by solving the crisis or offering understanding. Family triangles may create emotional instability in the long run and aren't optimal for dealing with problems in an open and direct way. There is nothing that indicates abuse. There is nothing to indicate neglect. Boundary blurring occurs when boundaries are diffuse, or unclear.

Sharing similar experiences is a curative factor identified by Yalom as universality. ventilation. reenactment. recapitulation.

universality. The phenomenon of understanding that one's problems are not unique helps group members feel secure and understood.