W2 Psych Questions

When a client is encouraged to talk with others who have had similar problems, the nurse is suggesting a which type of group? A. Cognitive-behavioral B. Time-limited C. Support group D. Milieu group

C. 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. None of the other options have this specific purpose as its focus.

Which phase of group therapy does the group deal with feelings associated with separation and loss? A. Orientation B. Working C. Termination D. Post-termination

C. 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. None of the other options are focused on the emotions associated with the ending of the group experience.

The nurse describing alternative and complementary therapies would best describe them using which phrase? A. Disease focused B. Conventional directed C. Symptom directed D. Holistically focused

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

The case manager is demonstrating an understanding of the primary goals of managed care when engaging in which client intervention? A. Arranging for the client to have a screening for prostate cancer B. Notifying the family that the client will require a wheelchair when discharged C. Providing the client with organizations that help defray the cost of prescribed drug D. Arranging for respite care when the client's family needs to attend an out-of-state affair

A. Arranging for the client to have a screening for prostate cancer The goal of managed care directed by a case manager is to provide coordination of all health services with an emphasis on preventive care. While appropriate interventions, none of the remaining options focus on preventive care.

Which of the following structural safety precautions is most important when attempting to prevent a common type of inpatient suicide? A. Break-away closet bars to prevent hanging B. Bedroom and dining areas with locked windows to prevent jumping C. Double-locked doors to prevent escaping from the unit D. Platform beds to prevent crush injuries

A. Break-away closet bars to prevent hanging Hangings are the most common method of inpatient suicide. The other options are important safety measures but don't directly address the suicide method of hanging.

A recent Hispanic immigrate comes to the mental health clinic after being referred to by her primary care provider. Josefina came to live in the United States from Brazil 5 years ago. During the initial intake assessment, the client reports headaches and backaches "almost every day" and "can't sleep at night." The client looks away when asked about anxiety or depression and states, "I don't know why I was referred to the mental health clinic." Which assessment information should the nurse further explore to assess for possible somatization? A. Impaired sleep patterns B. Denial of anxiety or depression C. Unexplained physical pain D. Recent immigration to the United States

B. Denial of anxiety or depression Somatization is described as experiencing and expressing emotional or psychological distress as physical symptoms. The client's behavior associated with the denial of any mental illness or understanding of the possible connection between the symptom/signs and a mental illness presents a need to explore the possibility of somatization. None of the other options support this possibility as directly.

What is the primary advantage of using a case manager when considering the planning and implementation of client care? A. Increases collaborative practice. B. Enhances resource management. C. Increases client satisfaction with care. D. Promotes evidence-based psychiatric nursing

B. Enhances resource management. Case management coordinates and monitors the effectiveness of services appropriate for the client. While the other options are true statements, none describes the primary advantage of the case manager model of health care delivery.

Which statement made by the nurse would acknowledge that they understand the difference between the ethnicity and culture? A. "So, ethnicity refers to having the same life goals whereas culture refers to race." B. "So, ethnicity refers to norms within a culture, and culture refers to shared likes and dislikes." C. "So, ethnicity refers to shared history and heritage, whereas culture refers to sharing the same beliefs and values." D. "So, ethnicity refers to race, and culture refers to having the same worldview."

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

The nurse caring for a client prescribed an antidepressant medication that produces anticholinergic side effects should assess for which possible side effects? (Select all that apply.) A. Memory dysfunction B. Ejaculatory dysfunction C. Blurred vision D. Dry mouth E. Constipation

C. Blurred vision D. Dry mouth E. Constipation Anticholinergic effects are the effects produced by atropine: dry mouth, dry eyes, blurred vision, constipation, and urinary retention. None of the remaining options are associated with anticholinergic side effects.

When a tumor of the cerebellum is present, the nurse should expect that the client would initially demonstrate which sign/symptom? A. Impaired balance B. Abnormal eye movement C. Impaired social judgment D. Blood pressure irregularities

A. Impaired balance The cerebellum is the organ primarily responsible for symptoms of equilibrium or imbalance and would not be a likely source of any of the other options.

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 which cultural concept? A. Supernatural causes B. Negative forces C. Inheritance D. Yin-Yang

D. Yin-Yang Many Eastern cultures explain illness as a function of imbalance such as Yin-Yang. None of the other options are widely reflected in the Chinese culture.

During what stage of the therapeutic nurse-client relationship is a formal or informal contract between the nurse and client established? A. Preorientation B. Orientation C. Working D. Termination

B. Orientation Contracting is part of the orientation phase of the relationship. Establishing the operational "rules" provides a foundation for the relationship. This function is not associated with any of the other options.

When considering the duty to warn and protect third parties, which client statement should the nurse report to the treatment team members? A. "That judge is going to really regret putting me in here." B. "All politicians need to be shot." C. "When I'm elected president, I'll make them all pay for doubting me." D. "The man out there who is laughing at me is going to die."

A. "That judge is going to really regret putting me in here." The duty to protect is an ethical and legal obligation of health care workers to protect patients from physically harming themselves or others. This duty arises when the patient presents a serious danger to another. While all that statements infer the client's intention to harm, only the correct option is credible since it actually identifies the possible victim.

Which statement regarding clients' rights after being voluntarily admitted to a behavioral health unit is true? A. All rights remain intact. B. Only rights that do not involve decision making remain intact. C. The right to refuse treatment is no longer guaranteed. D. All rights are temporarily suspended.

A. All rights remain intact. The hospitalized client is not a convicted criminal thus all civil rights remain intact.

When treating mental illnesses with psychotropic drugs what is the focus of the treatment? A. Altering brain neurochemistry. B. Correcting brain anatomical defects. C. Regulating social behaviors. D. Activating the body's normal response to stress.

A. Altering brain neurochemistry. Psychotropic drugs act to increase or decrease neurotransmitter substances within the brain, thus altering brain neurochemistry.

The nurse caring for a client prescribed risperidone observes the client carefully for which possible side effects? (Select all that apply.) A. Daytime sleepiness B. Reports of heartburn C. A rapid heartbeat D. Sexual dysfunction E. A weight gain

A. Daytime sleepiness D. Sexual dysfunction E. A weight gain

Which statements are true regarding the differences between a social relationship and a therapeutic relationship? (Select all that apply.) A. In a social relationship... B. A social relationship is instituted for the main purpose of exploring one member's feelings and issues; a therapeutic relationship is instituted for the purpose of friendship. C. Giving advice is done in social relationships; in therapeutic relationships giving advice is not usually therapeutic. D. In a social relationship, both parties come up with solutions to problems and solutions may be implemented by both (a friend may lend the other money, etc.); in a therapeutic relationship, solutions are discussed but are only implemented by the patient. E. In a social relationship, communication is usually deep and evaluated; in a therapeutic relationship, communication remains on a more superficial level, allowing patients to feel comfortable.

A. In a social relationship, both parties' needs are met; in a therapeutic relationship, only the patient's needs are to be considered. C. Giving advice is done in social relationships; in therapeutic relationships giving advice is not usually therapeutic. D. In a social relationship, both parties come up with solutions to problems and solutions may be implemented by both (a friend may lend the other money, etc.); in a therapeutic relationship, solutions are discussed but are only implemented by the patient. The other options describe the opposite meanings of social and therapeutic relationships.

A nurse on the psychiatric unit has a past history of alcoholism and has regular meetings with a mentor. Which statement made to the nurse's mentor would indicate the presence of countertransference? A. "My patient is being discharged tomorrow. I provided discharge teaching and stressed the importance of calling the help line number should she become suicidal again." B. "My patient has been abusing alcohol. I told her that the only way to recover was to go 'cold turkey' and to get away from her dysfunctional family and to do it now!" C. "My patient started drinking after 14 years of sobriety. We are focusing on his treatment plan of attending AA (Alcoholics Anonymous) meetings five times a week after discharge." D. "My patient, is an elderly woman with depression. She calls me by her daughter's name because she says I remind her of her daughter."

B. "My patient has been abusing alcohol. I told her that the only way to recover was to go 'cold turkey' and to get away from her dysfunctional family and to do it now!" This statement indicates countertransference; the nurse may be overidentifying with the patient because of a past history of alcoholism. Providing adamant advice to the patient that, besides being nontherapeutic, may be more relevant to personal past experiences than to the patient's. The discharge teaching for a patient being discharged and focusing on the treatment plan for the alcoholic patient are appropriate and show no signs of countertransference. The patient calling the nurse by her daughter's name is transference rather than countertransference.

When a nurse says, "I work with a mobile mental health unit," what assumption can a client accurately make about the care being provided? A. The clients who are convicted criminals sentenced to home confinement. B. Care is provided to clients in unconventional settings. C. Care is provided by a preferred provider for a large HMO. D. The clients are provided for by a clinical specialist with the visiting nurse service.

B. Care is provided to clients in unconventional settings. Mobile mental health units travel throughout the community, seeing clients on their own "turf," such as in shelters, on street corners, in homes, and at factories.

Which question asked by a nurse demonstrates the effective implementation of cultural desire when caring for a client from a different culture? A. "Where can I find information on the concept of Yin-Yang?" B. "How do I go about arranging for a Chinese translator?" C. "What can I do to provide ethnic foods that are still low in fat?" D. "How can I explain why we can't provide for his request for acupuncture?"

C. "What can I do to provide ethnic foods that are still low in fat?" Cultural desire is a genuine interest in the client's unique perspective; it enables nurses to provide considerate, flexible, and respectful care to clients of all cultures. Attempting to incorporate ethnic foods into the client's prescribed diet demonstrates all these characteristics. None of the other options are focused on providing such care.

Which scenarios describe a Health Insurance Portability and Accountability Act (HIPAA) violation associated with a nurse's behavior? A. An ED (Emergency Department) nurse gives the intensive care unit nurse a client report from a telephone at the nurse's station. B. A nurse on the medical-surgical floor calls a patient's primary care provider to obtain a list of current medications. C. A nurse on the cardiac unit gives report to the nurse on the step-down unit while transporting a client in the staff elevator. D. A nurse on the psychiatric unit gives discharge information to the counseling office regarding a client's outpatient treatment.

C. A nurse on the cardiac unit gives report to the nurse on the step-down unit while transporting a client in the staff elevator. Discussing a patient's information in public places where it may be overheard is a violation of a patient's confidentiality. The other options describe appropriate interactions for patient continuity of care and support of the treatment plan by the health care team.

If a nurse is charged with leaving a suicidal client unattended, it is being suggested that the nurse's behavior has violated which ethical principle? A. Autonomy B. Veracity C. Fidelity D. Justice

C. Fidelity Fidelity refers to being "true" or faithful to one's obligations to the client. Client abandonment would be a violation of fidelity. None of the other options addressed abandonment.

A nurse states, "I am so frustrated trying to communicate with clients when they insist on speaking in their 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 response by a peer best promotes culturally competent care? (Select all that apply.) A. "You are right, but all clients do have a right to an interpreter, so you need to comply." B. "I agree that it is frustrating. We should work with their family members to help convince them to speak English." C. "They will have to learn to speak English eventually to live and work successfully in this country. Just try to be client and encourage them to try speaking English." D. "What you are saying is actually considered cultural imposition, which is imposing our own culture onto someone from a different culture." E. "When their ability to speak and understand English

D. "What you are saying is actually considered cultural imposition, which is imposing our own culture onto someone from a different culture." E. "When their ability to speak and understand English is very limited, we need to have an interpreter present to make sure they can make their 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 client can communicate his feelings and needs thoroughly to the staff. Clients 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 client to speak English is not promoting culturally competent care and also undermines the trust between nurse and client. Instead of encouraging the client to speak English, an interpreter should be obtained for the client.

In the Chinese tradition, disease is believed to be caused by what factor? A. Fluctuations in opposing forces B. Outside influences C. Members' disobedience D. Adoption of Western beliefs

A. Fluctuations in opposing forces In the Eastern tradition, disease is believed to be caused by fluctuations in opposing forces. None of the other options are included in the Chinese view of disease.

A therapeutic inpatient milieu will include which characteristic? A. It provides for the client's safety and comfort. B. Voluntarily admitted clients are generally allowed additional privileges. C. Rules and behavioral limits are flexibly enforced. D. Staff provide frequent and ongoing negative feedback to clients

A. It provides for the client's safety and comfort. Because the acuity level on inpatient units is high, nurses are responsible for ensuring that the environment is safe, and that elopement and self-harm opportunities are minimized. The other choices are undesirable characteristics of a therapeutic milieu.

In addition to physicians, what other members of the mental health disciplines have been identified as having the knowledge, skills, ability, and legal authority to intervene in the full range of mental health care? A. Nurses B. Social workers C. Clinical psychologists D. Chemical dependency counselors

A. Nurses Nurses are the only caregivers listed who can provide both physical and psychological care for mental health clients.

According to the Western scientific view of health, what causes illness? A. Pathogens B. Energy blockage C. Spirit invasion D. Soul loss

A. Pathogens Disease has a cause (e.g., pathogens, toxins) that creates the effect; disease can be observed and measured. None of the other concepts are considered as illness produced by the Western view of health.

Most clients who are diagnosed with chronic mental illness are not likely to have their psychiatric mental health experiences covered by which payment method? A. Private insurance B. Medicare C. Medicaid D. Private pay

A. Private insurance Because most health insurance is employer based, few chronically ill clients have private insurance. The other options are examples of ways clients pay for their needed mental health services.

The incoherent thought and speech patterns of the client diagnosed with schizophrenia are related to the brain's inability to perform which function? A. Regulate conscious mental activity. B. Retain and recall past experience. C. Regulate social behavior. D. Maintain homeostasis.

A. Regulate conscious mental activity. When the brain cannot regulate conscious mental activity, the individual's speech patterns demonstrate incoherence and lack of reality orientation.

When considering the civil rights of persons diagnosed with mental illness and hospitalized for treatment, which statement is true? A. They are assured the same as those for any other citizen. B. Their rights are altered to prevent use of poor judgment. C. Their rights are always ensured by appointment of a guardian. D. Their rights are limited to provision of humane treatment

A. They are assured the same as those for any other citizen. Civil rights are not lost because of hospitalization for mental illness. None of the other statements are accurate when describing the rights of a hospitalized mentally ill client.

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

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

A client has been admitted to an inpatient psychiatric unit with suicidal ideation. In a one-to-one session with the nurse, he shares the terrible guilt he feels over sexually abusing his stepdaughter and wanting to die because of it. Which response reflects a helpful trait in a therapeutic relationship? A. "It's good that you feel guilty. That means you still have a chance of being helped." B. "Of course you feel guilty. You did a horrendous thing. You shouldn't even forget what you did." C. "The biggest question is, will you do it again? You will end up having even worse guilt feelings because you hurt someone again." D. "You are suffering with guilt over what you did. Let's talk about some goals we could work on that may make you want to keep living."

D. "You are suffering with guilt over what you did. Let's talk about some goals we could work on that may make you want to keep living." This response demonstrates suspending value judgment, a helpful trait in establishing and maintaining a therapeutic relationship. Although it is difficult, nurses are more effective when they don't use their own value systems to judge patients' thoughts, feelings, or behaviors. The other options are all judgmental responses. Judgment on the part of the nurse will most likely interfere with further explorations of feelings and hinder the therapeutic relationship.

Based on the current understanding of brain physiology, which neurotransmitter would be the expected target of medication prescribed to manage depression? (Select all that apply.) 1. Dopamine 2. γ-aminobutyric acid (GABA) 3. Serotonin 4. Norepinephrine 5. Acetylcholine

1. Dopamine 3. Serotonin 4. Norepinephrine Antidepressant medication targets serotonin and norepinephrine. While dopamine is implicated in schizophrenia (increase) and Parkinson's disease (decrease), it is also believed to be a factor in depression. GABA is implicated in anxiety disorders. Acetylcholine is implicated in Alzheimer's disease as well as Huntington's disease and Parkinson's disease.

A 49-year-old client diagnosed with schizophrenia at 22 years old is prescribed risperidone. Which nursing assessment is the priority for this client? 1. Monitoring blood levels to avoid toxicity 2. Monitoring for abnormal involuntary movements 3. Observing for secondary mania 4. Observing for memory changes

2. Monitoring for abnormal involuntary movements Risperidone has the highest rate of extrapyramidal side effects (EPSs) of the second-generation antipsychotic medications, thus making it imperative to monitor for EPSs. Risperidone is not monitored with blood levels and does not cause mania or memory changes.

A prescription for which medication would require the nurse to monitor the client for potential development of the side effect of hypothyroidism? 1. Fluoxetine 2. Bupropion 3. Lithium 4. Imipramine

3. Lithium Long-term use of lithium may cause hypothyroidism. The other options refer to drugs whose long-term use does not cause hypothyroidism.

A 38-year-old client diagnosed with major depression states, "my provider said something about the medicine I've been prescribed will affect my neurotransmitters. What exactly are neurotransmitters?" What is the nurse's best response to the client's question? A. "Neurotransmitters are chemical messengers in the brain that help regulate specific functions such as depression." B. "Neurotransmitters are too complicated to explain easily. Just know that the medication will help your mood and make you less depressed." C. "Neurotransmitters are chemicals in the brain that are the reason you are depressed." D. "I will ask your provider to give you a more in-depth explanation about why this medication will help your depression."

A. "Neurotransmitters are chemical messengers in the brain that help regulate specific functions such as depression." Neurotransmitters are chemicals released from neurons that function as a neuromessenger and influence brain functions. Telling the client that the answer is too complicated belittles the client by implying she cannot understand, while stating that neurotransmitters are the reason, she is depressed is too simplistic. Asking the provider to give the education abdicates your responsibility to provide client education.

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

A. "What do you think is making you ill?" Asking the client to suggest reasons for the illness will best provide an opportunity to become familiar with general beliefs and values the client holds regarding his wellness. While appropriate assessment questions, none of the remaining options are as well suited to gather culturally influenced information.

Which of the following statements represent a nontherapeutic communication technique? (Select all that apply.) A. "Why didn't you attend group this morning?" B. "From what you have said, you have great difficulty sleeping at night." C. "What did your boyfriend do that made you leave? Are you angry at him? Did he abuse you in some way?" D. "If I were you, I would quit the stressful job and find something else." E. "I'm really proud of you for the way you stood up to your brother when he visited today." F. "You mentioned that you have never had friends. Tell me more about that." G. "It sounds like you have been having a very hard time at home lately."

A. "Why didn't you attend group this morning?" C. "What did your boyfriend do that made you leave? Are you angry at him? Did he abuse you in some way?" D. "If I were you, I would quit the stressful job and find something else." E. "I'm really proud of you for the way you stood up to your brother when he visited today." All these options reflect the nontherapeutic techniques of (in order) asking "why" questions; using excessive questioning; giving advice; and giving approval. The other options describe therapeutic techniques of restating, exploring, and reflecting.

Which hospitalized patient should the nurse identify as being a candidate for the appropriate use of a release from hospitalization known as against medical advice (AMA)? A. A 37-year-old patient scheduled for discharge in 24 hours wishes to be discharged immediately B. A 75-year-old patient with dementia who demands to be allowed to go back to his own home C. A 21-year-old actively suicidal patient who wants to be discharged to home and do outpatient counseling D. A 32-year-old female patient who wishes to stay in the hospital but whose husband demands that she be discharged into his care

A. A 37-year-old patient scheduled for discharge in 24 hours wishes to be discharged immediately AMA discharges are sometimes used when the patient does not agree with the provider, as long as the patient is not a danger to himself or herself or to others. The patient with dementia and the patient who is actively suicidal would pose a safety risk and would be not allowed to be discharged AMA. A patient who wishes to stay in the hospital can make that decision; a family member's opinion doesn't impact an AMA discharge.

A chiropractic practitioner will explain to clients that chiropractic treatments are effective based on what information? A. Adjustments put the spinal column in a normal position allowing improved energy flow. B. Manipulation of soft tissue reduces muscle spasm and produces relaxation. C. The laying on of hands reduces stress and produces relaxation. D. Needle placement modulates the flow of energy along body meridians.

A. 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. None of the other options accurately relate to chiropractic therapy.

When a group member supports and encourages another group member and feels "good" about doing so, which group phenomenon is being demonstrated? A. Altruism B. Catharsis C. Cohesiveness D. Instillation of hope

A. Altruism Altruism involves putting another's needs before one's own. This is the only option that correctly identifies with the example provide in the question.

When a client states "That nurse never seems comfortable being with me." How is the client characterizing the nurse? A. As not seeming genuine to the client. B. As transmitting fear of clients. C. As being unfriendly and aloof. D. As being controlling.

A. As not seeming genuine to the client. Hiding behind a role, using stiff or formal interactions, and creating distance between self and client suggest a nurse is lacking in genuineness, or the ability to interact in a person-to-person fashion. This characteristic is not associated with the other options.

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

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

The use of seclusion or restraint to control the behavior of a client who is at risk of harming self or others gives rise to conflict between which ethical principles? A. Autonomy and beneficence B. Advocacy and confidentiality C. Veracity and fidelity D. Justice and humanism

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

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

A. Beliefs and values held by people of a given culture about what is good, right, and normal. A worldview is a system of thinking about how the world works and how people should behave in the world and toward each other. It is from this view that people develop beliefs, values, and the practices that guide their lives. None of the other statements accurately describe the term worldview.

The nurse is finding it difficult to provide structure and set limits for a client. The nurse should self-evaluate for which characteristic of a dysfunctional nurse-patient relationship? A. Boundary blurring B. Value dissonance C. Covert anger D. Empathy

A. Boundary blurring Boundary blurring is often signaled by the nurse being either too helpful or not helpful enough. The behavior is not associated with any of the other options.

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

A. 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.

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 related to what possible experience? A. Depression B. Hallucinations C. Fears D. Alcohol abuse

A. Depression St. John's wort is primarily used by individuals to elevate a depressed mood. None of the other options are relevant to the use of St. John's wort.

What are the advantages of therapy groups? (Select all that apply.) A. Feedback from peers B. Treatment of multiple people at one time C. Promotion of independence in problem solving D. Provision of an opportunity to practice communication E. Promotion of a feeling of belonging F. Promotion of confidentiality

A. Feedback from peers B. Treatment of multiple people at one time D. Provision of an opportunity to practice communication E. Promotion of a feeling of belonging All these options are advantages of groups. Since the members openly discuss and provide feedback, confidentiality is not possible.

The nurse would address which of the following goals in attempting to establish a therapeutic nurse-client relationship? (Select all that apply.) A. Helping patients examine self-defeating behaviors and test alternatives B. Promoting self-care and independence C. Providing the client with opportunities to socialize D. Assisting patients with problem solving to help facilitate activities of daily living E. Facilitating communication of distressing thoughts and feelings

A. Helping patients examine self-defeating behaviors and test alternatives B. Promoting self-care and independence D. Assisting patients with problem solving to help facilitate activities of daily living E. Facilitating communication of distressing thoughts and feelings Addressing the client's need to socialize is not one of the goals of establishing a therapeutic relationship. The other options are goals addressed in a therapeutic relationship.

What are the risks associated with the use of complementary and alternative medicine (CAM) therapies? (Select all that apply.) A. Lack of standards or regulations that ensure safety for herbal products. B. There are no specialized educational programs that focus on CAM therapies. C. Interactions between CAM products and prescribed medication. D. Insurance companies do not always cover these forms of treatment. E. Credentialing is unavailable for most CAM modalities

A. Lack of standards or regulations that ensure safety for herbal products. C. Interactions between CAM products and prescribed medication. D. Insurance companies do not always cover these forms of treatment. Poor standardization of herbal products and the possible drug-to-herb interaction as well as the fact that these therapies may not be covered by health care insurance are risks associated with CAM therapies. The remaining options are untrue statements concerning CAM therapies.

The medication prescribed for a client acts by blocking reuptake of both serotonin and norepinephrine. The nurse evaluates the treatment as successful when observing which client behavior? A. Laughing at a joke B. Apologizing for being sarcastic C. Writing down a telephone number D. Going to his room to "calm down"

A. Laughing at a joke Depression is thought to be at least in part caused by lowered levels of serotonin and norepinephrine. Increasing the amount of these transmitters in the brain by blocking reuptake may result in mood elevation. While the other options demonstrate positive behaviors, none are directly associated with such a medication.

The nurse responsible for the care of a client prescribed clonazepam should evaluate treatment as being successful when the client demonstrates which behavior? A. Less anxiety B. Normal appetite C. Improved physical balance D. Reduced auditory hallucinations

A. Less anxiety Clonazepam is a benzodiazepine thought to enhance the effects of GABA. GABA is associated with the production of a calming emotional state. None of the other options are associated with clonazepam.

A client states, "I found out that I was in the section of the research study not actually taking the medicine. I don't understand that, because all my symptoms improved!" This reaction may be related to what concept? A. Mind-body effect B. Meditation C. Homeopathy D. Naturopathy

A. Mind-body effect Mind and body approaches are built on theories that focus on the continuous interaction between mind and body. Most of these techniques emphasize the mind's capacity to affect bodily function and symptoms, but the reverse—the effects of bodily illness on mental health—is also part of the equation. None of the remaining options are associated with the patient's statement.

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? A. No manufacturing standardization exists. B. Clients are unreliable resources of medication information. C. Pure drug is cut with impure substances before going on sale in stores. D. Underdosage leads to poor results from herbal supplements

A. 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 group phase is most influenced and managed by the group leader? A. Orientation B. Working C. Termination D. Post-termination

A. Orientation The group leader often is most directive in the orientation phase, in which roles and ground rules are set. No other phase is so managed by the leader.

A nurse is asked by a client about the basis for the nutritional treatment of health problems. The best reply would incorporate the information that alternative and complementary therapies are based on what factual information? A. Research-based findings B. Cultural and historical experience C. Consumer satisfaction with the conventional Western healing system D. Consumer dissatisfaction with conventional Western healing methods

A. Research-based findings There is a good deal of research on the influence of diet and nutrition on general health, as well as mental health. The International Society for Nutritional Psychiatry Research (ISNPR) was established to study nutritional approaches to the prevention and treatment of mental disorders and their comorbidities and numerous study links can be found on their website.

When preparing to hold an admission interview with a client, the nurse pulls up a chair and sits facing the client with their knees almost touching. When the nurse leans in close to speak, the client becomes visibly flustered and gets up and leaves the room. What is the most likely explanation for client's behavior? A. The nurse violated the client's personal space by physically being too close. B. The client has issues with sharing personal information. C. The nurse failed to explain the purpose of the admission interview. D. The client is responding to the voices by ending the conversation.

A. The nurse violated the client's personal space by physically being too close. By sitting and leaning in so closely, the nurse has entered into intimate space (0 to 18 inches), rather than social distance. This has likely made the client may feel uncomfortable with being so close to someone unknown to them. All the other options lack evidence and jump to conclusions regarding the client's behavior.

What is the focus during clinical supervision? A. The nurse's behavior in the nurse-client relationship B. Analysis of the client's motivation for transferences C. Devising alternative strategies for client growth D. Assisting the client to develop increased independence

A. The nurse's behavior in the nurse-client relationship Clinical supervision helps the nurse look at his or her own behavior and determine more effective approaches to working with clients. None of the other options are associated with clinical supervision.

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 which complementary therapy? A. Therapeutic touch B. Acupuncture C. Orthomolecular therapy D. Eye movement desensitization reprocessing

A. 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. The information in the scenario does not support any of the other options.

A client says to the nurse, "I am going to stop taking these antidepressants and start using herbs. What is the most likely reason for the client's decision to use herbals? A. They generally cost less. B. They often produce a faster cure. C. Generally have no side effects D. They are recommended by trusted folk healers.

A. They generally cost less. Although not inexpensive, herbal preparations are often less expensive than prescription medication, especially a newer medication still under patent. While the other options can be related, they are not as regularly identified as the trigger for the client's decision to use herbs to substitute for prescribed medications.

Sharing similar experiences in a group setting is referred to using which term? A. Universality B. Imparting information C. Socializing D. Catharsis

A. Universality The phenomenon of understanding that one's problems are not unique helps group members feel secure and understood and is an example of universality. No other option is used to describe this group behavior.

When considering mental illness, recovery is best described to a client by which statement? A. Working, living, and participating in the community B. Never having to visit a mental health provider again C. Being able to understand the nature of the diagnosed illness D. A period of time when signs and symptoms are being managed

A. Working, living, and participating in the community Recovery is described as the ability of the individual to work, live, and participate in the community. Never having to visit a mental health provider is unrealistic. While important to recovery understanding of the disorder is not a demonstration of recovery. Remission is a period of time when signs and symptoms are being managed.

What is the basic functional unit of the nervous system called? A. neuron. B. synapse. C. receptor. D. neurotransmitter.

A. neuron. Neurons are nerve cells. Cells are the basic unit of function. A neurotransmitter is a chemical substance that functions as a neuromessenger. This neurotransmitter then diffuses across a space, or synapse, to an adjacent postsynaptic neuron, where it attaches to receptors on the neuron's surface.

Cells that respond to stimuli, conduct electrical impulses, and release neurotransmitters are called A. neurons. B. synapses. C. dendrites. D. receptors.

A. neurons. Neurons are the basic functional unit of the nervous system responsible for sending and receiving messages as electrochemical events.

A client was admitted to the behavioral health unit for evaluation and diagnosis after being found wandering the streets. His personal hygiene is poor, and his responses to questions are bizarre and inappropriate. The client's constitutional rights are violated when the nurse makes which statement? A. "We will help you make decisions that will keep you safe." B. "I am going to help you shower, so you will not smell so bad." C. "Your pocketknife and nail clippers will be kept in the nurses' station." D. "You will be having a number of tests to help us learn about your condition."

B. "I am going to help you shower, so you will not smell so bad." Every client has the right to be treated with dignity. This statement is demeaning. All of the other statements support the client's rights.

What is the most helpful nursing response to a client who reports thinking of dropping out of college because it is too stressful? A. "Don't let them beat you! Fight back!" B. "School is stressful. What do you find most stressful?" C. "I know just what you are going through. The stress is terrible." D. "You have only two more semesters. You will be glad if you stick it out."

B. "School is stressful. What do you find most stressful?" This response acknowledges the speaker's perception of school as difficult and asks for further information. This response suggests the nurse is listening actively and is concerned.

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

B. "What usually helps people who have the same type of illness you have?" Asking about typical treatment seeks information about the "usual" cultural treatment of the disorder experienced by the client. No other option focuses on this information.

A client on the psychiatric unit asks the nurse, "What does group work mean? I was told I would be going to group and doing group work." How should the nurse respond to provide the best answer to the client's question? A. "You will attend group therapy and find solutions for each other's problems." B. "You will give and receive feedback from a group of your peers who may also have similar problems to work through." C. "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." D. "Group work is the work that you do beforehand so you can present it to the group when you meet."

B. "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. None of the other options accurately and adequately describe group work.

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." A. Preorientation B. Orientation C. Working D. Termination

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

Which of the following clients would be appropriate to refer to a partial hospitalization program (PHP)? A. A depressed client with a suicidal plan B. A client being discharged from an inpatient alcohol rehabilitation unit C. A client who has stopped taking his or her antipsychotic medication and is neglecting his or her basic needs D. Jeff, who has mild depression symptoms and is starting outpatient therapy

B. A client being discharged from an inpatient alcohol rehabilitation unit PHP is for clients who may need a "step-down" environment from inpatient status or for those who are being diverted from hospitalization with intensive, short-term care from which they return home each day. This client would be a good candidate after completing alcohol rehab; PHP could possibly help prevent relapse in the early stages after rehab. This client can be managed with regular outpatient therapy and does not need intensive short-term therapy such as PHP. Someone who is suicidal would require inpatient hospitalization for safety as would someone who is decompensated and not caring for herself. A client exhibiting mild depression would be managed with outpatient therapy and would not need intensive short-term therapy such as PHP.

The client at the alcohol treatment center tells the 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 which integrative therapy? A. Allopathy B. Acupuncture C. Naturopathy D. Chi manipulation

B. 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). The information in the scenario does not support any of the other options.

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

B. Autonomy Autonomy refers to self-determination, or the right to make one's own decisions. None of the other options are directly related to the client's right to makes decisions.

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 what action? A. Insight B. Focusing C. Reframing D. Feedback

B. Focusing Focusing helps the group consider one problem rather than trying to attend to multiple problems at one time. None of the other options are associated with selecting a particular focus.

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 which form of complementary therapy? A. Allopathy B. Homeopathy C. Naturopathy D. Orthomolecular therapy

B. 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. The information in the scenario does not support any of the other options.

Which organ secretes hormones that are a normal component of the body's general response to stress? (Select all that apply.) A. Thyroid gland B. Hypothalamus C. Pituitary gland D. Adrenal glands E. Parathyroid glands

B. Hypothalamus C. Pituitary gland D. Adrenal glands

What term is used to describe care that places the attention on a patient's physical, mental, and spiritual needs while focusing on prevention and wellness? A. Orthodox B. Integrative C. Allopathic D. Mainstream

B. 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.

When considering the ongoing, crucial responsibilities of nurses working on an inpatient psychiatric unit, which activity has highest priority? A. Fostering research B. Maintaining a therapeutic milieu C. Providing sympathetic listening D. Providing constructive negative feedback

B. Maintaining a therapeutic milieu Nursing is the discipline primarily responsible for maintenance of a therapeutic milieu, an environment that serves as a real-life training ground for learning about self and practicing communication and coping skills in preparation for a return to the community outside the hospital. While the remaining options are nursing responsibilities, none has the priority of maintaining a therapeutic milieu.

Which imaging technique can provide information about brain function? A. Computed tomography (CT) scan B. Positron emission tomography (PET) scan C. Magnetic resonance imaging (MRI) scan D. Skull radiograph

B. Positron emission tomography (PET) scan The positron emission tomography scan provides information about function; the other imaging techniques provide information about structure.

The nurse who provides therapeutic milieu management supports the clients best by concentrating on which client need? A. Opportunity to act out fears and frustrations B. Providing a safe place to practice coping skills C. Meeting their physical as well as emotional needs D. Encouraging group communication about existing problems

B. Providing a safe place to practice coping skills A therapeutic milieu can serve as a real-life training ground for learning about the self and practicing communication and coping skills in preparation for a return to the community. The other options are considered components of a therapeutic milieu.

The nurse is caring for an admitted client with a history of becoming aggressive when angry and has caused physical injury to another client and two staff members. When this client begins to demonstrate signs of anger while in the day room what intervention should the nurse implement to address the safety of the milieu? A. Alert security to come to the unit for a show of strength B. Request that the client accompany the nurse to the client's room C. Inform the client that restraints will be used if the behavior continues D. Prepare to administer a prn chemical restraint to the client

B. Request that the client accompany the nurse to the client's room Least restrictive alternative doctrine requires using the least drastic means of achieving a specific goal. By first attempting to remove the client to a safer location, the nurse is respecting the client's right to treatment that is less restrictive than the other options.

A patient diagnosed with borderline personality disorder is attending a court-ordered therapy group. The patient projects an angry affect, does not speak much, except 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 patient's behavior? A. Remove the patient from the group because this behavior is disrupting the group process for other participants. B. Respond neutrally to the patient's comments, ask for group feedback, and talk privately with the patient to form a therapeutic connection. C. Spend an entire group session focused on that patient and try to get him/her to open up to other members in depth. D. Confront the patient firmly each time he/she makes a rude comment and let him/her know they will be taken out of group if the behavior continues.

B. Respond neutrally to the patient's comments, ask for group feedback, and talk privately with the patient to form a therapeutic 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.

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

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

A 52-year-old Chinese American client comes to the emergency room reporting anxiety and states, "I am a failure." During the assessment interview, the client shares that they have recently been reprimanded at work for an error they were responsible for. The nurse should explore which possible trigger for the client's anxiety and feelings of failure? A. The inability to achieve her personal goals in the workplace B. Shaming the family by being responsible for the error C. Feeling personally inadequate regarding dependability D. Traditional belief that failure may result in a changed fate

B. Shaming the family by being responsible for the error Eastern tradition, such as in China, 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.

Which function is classified as a circadian rhythm? A. Sex drive B. Sleep cycle C. Skeletal muscle contraction D. Maintenance of a focused stream of consciousness

B. Sleep cycle Circadian rhythms are biological rhythms that influence specific regulatory functions such as body temperature, sleeping and waking, and the secretion of certain hormones and neurotransmitters.

Which supplement may be helpful in managing the symptoms of depression? (Select all that apply.) A. Lavender B. St. John's wort C. Melatonin D. Fish oil E. SAMe

B. St. John's wort D. Fish oil E. SAMe St. John's wort, Fish oil, and SAMe have been identified as having some possible positive effect on the symptoms of depression. Melatonin and lavender are associated with insomnia.

Homeostasis is promoted by interaction between the brain and internal organs and is mediated by component of the nervous system? A. The central nervous system B. The autonomic nervous system C. The sympathetic nervous system D. The parasympathetic nervous system

B. The autonomic nervous system The function of the autonomic nervous system is to transmit messages between the brain and the internal organs. This linkage promotes the maintenance of homeostasis.

What is the best example of an alternative medical system? A. Psychotropic medication B. Chiropractic adjustment C. Homeopathy D. Allopathy

C. 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.

When considering client rights, which client can be legally medicated against his or her wishes? A. The client has accepted the medication in the past. B. The client may cause imminent harm to self or others. C. The client's primary provider orders the medication. D. The client's mental illness may relate to cognitive impairment.

B. The client may cause imminent harm to self or others. A patient may be medicated against their will without a court hearing in an emergency if the patient poses a danger to himself or herself or to others. The other options are not legally valid reasons to give medication against a patient's will.

The preferred seating arrangement for a nurse-client interview should incorporate which positioning? A. The nurse behind a desk and the client in a chair in front of the desk. B. The nurse and client sitting at a 90-degree angle to each other. C. The client sitting in a chair and the nurse standing a few feet away. D. The nurse and client sitting facing each other.

B. The nurse and client sitting at a 90-degree angle to each other. This arrangement allows the nurse to observe the client but places no barriers between the principals. The two are at the same height, so neither is in an inferior position. Face-to-face seating is a more confrontational arrangement and therefore more anxiety producing.

A 55-year-old client recently came to the United States from England on a work visa. The client was admitted for severe depression following the death of a life partner weeks ago. While discussing the death and its effects the client shows little emotion. Which of the following explanations is most plausible for this lack of emotion? A. The client in denial. B. The response may reflect cultural norms. C. The response may reflect personal guilt. D. The client may have an antisocial personality

B. The response may reflect cultural norms. Showing little emotion while in distress may be a cultural phenomenon. Some cultures, such as the British and German cultures, tend to value highly the concept of self-control and may show little facial emotion in the presence of emotional turmoil. There is no evidence to suggest the client's lack of emotion is a result of any of the other options.

When a nurse and client meet informally or have an otherwise limited but helpful relationship, what term is used to identify this relationship? A. Crisis intervention B. Therapeutic encounter C. Autonomous interaction D. Preorientation phenomenon

B. Therapeutic encounter A therapeutic encounter is a short but helpful interaction between the nurse and client. None of the other options reflect this form of relationship.

What therapeutic communication technique is the nurse using by asking a newly admitted client, "Can you tell me what was happening to you that led to your being hospitalized here?" A. Using a minimal encourager B. Using an open-ended question C. Paraphrasing D. Reflecting

B. Using an open-ended question Open-ended questions require more than one-word answers. None of the other options provide such flexibility.

What nursing action supports a client's right to autonomy? A. Spending time with an extremely anxious client B. Witnessing the informed consent for electroconvulsive therapy from a client C. Spending equal amount of one-on-one time with each client on the unit D. Attending an in-service on a newly approved medication

B. Witnessing the informed consent for electroconvulsive therapy from a client Autonomy refers to self-determination. One way to exercise self-determination is to make decisions about one's care. Witnessing the client's informed consent demonstrates attention to the client's right to autonomy. None of the other options are associated with autonomy.

When several group members always sit together and nod or smirk as others are talking, the leader assesses this behavior using which term? A. Confronting B. Blocking C. Subgrouping D. Imitating

C. 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. None of the other options are associated with behavior.

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? A. "You are taking only the medicines the doctor prescribed and, in the amounts, prescribed, correct?" B. "Tell me how you take the medicines the doctor prescribed for you." C. "Tell me every pill and supplement you take regularly." D. "What things do you do for yourself to improve your health?"

C. "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.

A patient who recently loss a parent begins crying during a one-to-one session with the nurse. Which response by the nurse illustrates empathy? A. "I'm so sorry. My father died 2 years ago, so I know how you are feeling." B. "You need to focus on yourself right now. You deserve to take time just for you." C. "That must have been such a hard situation for you to deal with." D. "I know that you will get over this. It just takes time."

C. "That must have been such a hard situation for you to deal with." This response reflects understanding of the patient's feelings, which is empathy. Feeling sorry for the client represents sympathy, whereas not addressing the patient's concern belittles the patient's feelings of grief she is expressing by changing the subject. Telling the patient, she will get over it does not reflect empathy and is closed-ended.

Which of the following clients meets the criteria for an involuntary admission to a psychiatric mental health unit? A. A 23-year-old college student who has developed symptoms of anxiety and is missing classes and work B. A 30-year-old accountant who has developed symptoms of depression C. A 26-year-old kindergarten teacher who is not in touch with reality and was found wandering in and out of traffic on a busy road D. A 76-year-old retired librarian who is experiencing memory loss and some confusion at times

C. A 26-year-old kindergarten teacher who is not in touch with reality and was found wandering in and out of traffic on a busy road Inpatient involuntary admission is reserved for clients who are at risk for self-harm or who cannot adequately protect themselves from harm because of their illness (e.g., a psychotic client). The other options can all be managed at this point in the community setting and don't meet criteria (risk of harm to self and/or others) for admission.

A democratic group leadership style is most appropriate for which purpose? A. 30-minute meetings to discuss unit rules B. Creating meaningful trauma-related artwork C. A group directed toward anger management D. The organization the unit's holiday celebration

C. A group directed toward anger management Democratic leadership is best implemented when extensive group interaction is devoted to problem solving. None of the other options is problem solving in its focus. The organization of the unit's holiday celebration may require more laissez-faire leadership because it is a creative project for a creative group.

Of the following environments, which would be most conducive to a therapeutic session? A. The nurses' station B. A table in the coffee shop C. A quiet section of the day room D. The utility room

C. A quiet section of the day room Of the options provided, a quiet corner of the day room offers the safest, quietest, most private environment for a therapeutic encounter. None of the other options offer these characteristics.

With which client should the nurse make the assessment that not using touch would probably be in the client's best interests? A. A recent immigrant from Russia B. A deeply depressed client C. A very private client D. A tearful client reporting pain

C. A very private client Some people perceive personal touch within the context of the nurse-client relationship as an invasion of their privacy.

Which nursing behavior best demonstrates the concept of cultural competence? A. Acquiring knowledge about different cultures B. Educating clients about the cultural norms of the United States C. Adjusting personal practice to meet the clients' cultural preferences, beliefs, and practices D. Engaging in continuing education classes on culture in the process of becoming culturally competent

C. Adjusting personal practice to meet the clients' cultural preferences, beliefs, and practices Cultural competence means that nurses adjust and conform to their clients' 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 clients 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.

A term is a synonym for the characteristic of genuineness? A. Respect B. Empathy C. Authentic D. Positive regard

C. Authentic Genuineness refers the nurse's ability to be open, honest, and authentic in interactions with patients. It is the ability to meet others person-to-person without hiding behind roles. While positive characteristics, none of the other options related to genuineness.

A client asks which herbal tea would be good to drink at bedtime. What should the nurse suggest? A. Green tea B. Black tea C. Chamomile tea D. Peppermint tea

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

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

C. Encouraging group members to reflect on progress made while providing group feedback. 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.

What term is used to describe the process implemented when members of a group are introduced to the culture's worldview, beliefs, values, and practices? A. Acculturation. B. Ethnocentrism. C. Enculturation. D. Cultural encounters.

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

If a client is placed in seclusion and held there for 24 hours without a written order or examination by a primary healthcare provider, the client has experienced which illegal act? A. Battery B. Defamation of character C. False imprisonment D. Assault

C. False imprisonment False imprisonment is the arbitrary holding of a client against his or her will. When seclusion is ordered, it is not invoked arbitrarily, but after other less restrictive measures have failed. If the client is secluded without the medical order, the measure cannot be proven as instituted for medically sound reasons. None of the other options relate directly to such seclusion.

A 53-year-old client with a pacemaker implant has been prescribed warfarin. The patient tells the nurse, "I feel so much better now that I've been taking ginseng to relieve my menopausal symptoms." The nurse's response should be based on what knowledge about ginseng? A. It is an appropriate herbal supplement for this patient. B. It has no proven effect on menopausal symptoms. C. It has anticoagulation effects. D. It is implicated in triggering strokes

C. It 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 nurse reading in a group's protocol notes that it is a closed group understands that the group demonstrates which characteristic? A. Discussion topics will be restricted. B. Membership is limited to one gender. C. No new members will be allowed. D. The group is focused on demonstrating cohesiveness.

C. No new members will be allowed. A closed group is one to which no members are added once the group has begun. The term closed does not refer to any of the other options.

A client is sitting with arms crossed over their chest, with their left leg is rapidly moving up and down, and there is an angry facial expression. When approached by the nurse, the client states harshly, "I'm fine! Everything's great." Which statement related to communication should the nurse focus on when working with this client? A. Verbal communication is always more accurate than nonverbal communication. B. Verbal communication is more straightforward, whereas nonverbal communication does not portray what a person is thinking. C. Nonverbal and verbal communication may be different; nurses must pay attention to the nonverbal communication being presented to get an accurate message. D. Nonverbal communication is about 10% of all communication, and verbal communication is about 90%.

C. Nonverbal and verbal communication may be different; nurses must pay attention to the nonverbal communication being presented to get an accurate message. Communication is roughly 10% verbal and 90% nonverbal, so nurses must pay close attention to nonverbal cues to accurately assess what the client is really feeling. The other options are all untrue of verbal and nonverbal communication and are actually the opposite of what is believed of communication.

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

C. Nothing may be disclosed that would have been kept confidential before death. Confidentiality extends to death and beyond. Nurses should never disclose information after the death of a client that they would have kept confidential while the client was alive. None of the other statements are accurate.

The psychiatric community health nurse engages in secondary prevention when implementing which intervention? A. Visiting a homeless shelter to provide mental health screenings for its clients B. Discussing the need for proper nutrition with a depressed new mother C. Providing stress reduction seminars at the local senior center D. Visiting the home of a client currently displaying manic behavior

C. Providing stress reduction seminars at the local senior center Secondary prevention is aimed at reducing the prevalence of psychiatric disorders. Early identification of problems, screening, and prompt and effective treatment are hallmarks of this level. While it does not stop the actual disorder from beginning, it is intended to delay or avert progression. None of the other options are focused on early identification of problems.

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

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

Which of the following is a herb commonly used to treat mild depression? A. Melatonin B. Kava C. St. John's wort D. Chamomile

C. St. John's wort St. John's wort is used for the treatment of mild to moderate depression. None of the other options are associated with the treatment of mild depression.

Which criterion must be met to refer a client to a partial hospitalization program? A. The client is hospitalized at night in an inpatient setting. B. The client must be able to provide his or her own transportation daily. C. The client is able to return home each day. D. The clients are all recovering from an addiction.

C. The client is able to return home each day. Returning home each day is a criterion because doing so allows the person to test out new skills and gradually re-enter the family and society. None of the remaining options are true statements regarding partial hospitalization programs.

The client makes the decision to sit about 5 feet away from the nurse during the assessment interview. The nurse can accurately make what assumption about the client's perception of the nurse? A. The nurse is a safe person to interact with. B. The nurse is a new friend. C. They view the nurse as a stranger. D. They view the nurse as a peer.

C. They view the nurse as a stranger. Social distance (4-12 feet) is reserved for strangers or acquaintances. This is often the client's perception of staff during the initial phase of relationship-building. This behavior is not associated with any perception provided by any other option.

What is the primary difference between a social and a therapeutic relationship? A. Type of information exchanged B. Amount of satisfaction felt C. Type of responsibility involved D. Amount of emotion invested

C. Type of responsibility involved In a therapeutic relationship the nurse assumes responsibility for focusing the relationship on the client's needs, facilitating communication, assisting the client with problem-solving, and helping the client identify and test alternative coping strategies.

The nurse reads the medical record and learns that a client has asked for treatment, agreed to receive treatment, and to abide by hospital rules. The client has met the criteria for which type of admission? A. Outpatient B. Emergency C. Voluntarily D. Involuntarily

C. Voluntarily Voluntary admission occurs when the client seeks treatment and is willing to be admitted and agrees to comply with hospital and unit rules. None of the other options meet all these criteria.

A client is presenting with behaviors that indicate anger. When approached, the client states harshly, "I'm fine! Everything's great." Which response should the nurse provide to the client? A. "Okay, but we are all here to help you, so come get one of the staff if you need to talk." B. "I'm glad everything is good. I am going to give you your schedule for the day and we can discuss how the groups are going." C. "I don't believe you. You are not being truthful with me." D. "It looks as though you are saying one thing but feeling another. Can you tell me what may be upsetting you?"

D. "It looks as though you are saying one thing but feeling another. Can you tell me what may be upsetting you?" This response uses the therapeutic technique of clarifying; it addresses the difference between the client's verbal and nonverbal communication and encourages sharing of feelings. The other options do not address the client's obvious distress or are confrontational and judgmental. None of the other options provides this support.

Consider the nurse-patient relationship on an inpatient psychiatric unit. Which statement made by the nurse reflects an accurate understanding of when the issue of termination should first be discussed? A."You are being discharged today, so I'd like to bring up the subject of termination—discussing your time here and summarizing what coping skills you have attained." B. "I haven't met my new patient yet, but I am working through my feelings of anxiety in dealing with a patient who wanted to kill herself." C. "Now that we are working on your problem-solving skills and behaviors, you'd like to change; I'd like to bring up the issue of termination." D. "Now that we've discussed your reasons for being here and how often we will meet; I'd like to talk about what we will do at the time of your discharge."

D. "Now that we've discussed your reasons for being here and how often we will meet; I'd like to talk about what we will do at the time of your discharge." The issue of termination is brought up first in the orientation phase. All the other options describe other phases of the nurse-patient relationship—the termination phase, the preorientation phase, and the working phase.

What response demonstrates an effective strategy to encourage a nonparticipating member to speak during a group session? A. "You are letting the group down when you fail to contribute." B. "Your opinions about what just happened are important." C. "You must be feeling safe enough to enter the discussion by now." D. "What you are thinking is very important to the group."

D. "What you are thinking is very important to the group." The incorrect options place the client on the defensive and encourage further withdrawal. The correct option is less threatening. The leader needs to be patient and, in a nonthreatening manner, encourage members to make contributions.

During a clinical interview the client falls silent after disclosing that she was sexually abused as a child. The nurse should engage in which intervention in response to the client's silence? A. Quickly break the silence and encourage the client to continue. B. Reassure the client that the abuse was not her fault. C. Reach out and gently touch the client's arm. D. Allow the client to break the silence.

D. Allow the client to break the silence. Silence is not a "bad" thing. It gives the speaker time to think through a point or collect his or her thoughts. None of the other options will assist with further communication with this client.

Which alternative and complementary treatment modality involves the use of essential oils to release neurotransmitters in the brain? A. Orthomolecular therapy B. Acupuncture C. Hypnosis D. Aromatherapy

D. 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. The information in the scenario does not support any of the other options.

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 provide which response? A. Remain silent and nod slightly to signal that the client should continue. B. Say, "Tell us more about how you are feeling." C. Ask, "Does this shaky feeling occur often?" D. Ask the group to give feedback about how the client appears to them.

D. 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. The remaining options either give encouragement to continue or seek additional information.

Which communication techniques should the nurse use with a client who has been identified as having difficulty expressing thoughts and feelings? A. Using emotionally charged words and gestures B. Offering opinions and avoiding periods of silence C. Asking closed-ended questions requiring "yes" or "no" answers D. Asking open-ended questions and seeking clarification

D. Asking open-ended questions and seeking clarification Open-ended questions give the client the widest possible latitude in answering. Also, the client can take the lead in the interview. Seeking clarification helps the client clarify his or her own thoughts and promotes mutual understanding. None of the options provide this support.

When discussing her husband, a client shares that "I would be better off alone. At least I would be able to come and go as I please and not have to be interrogated all the time." What therapeutic communication technique is the nurse using when responding, "Are you saying that things would be better if you left your husband?" A. Focusing B. Restating C. Reflection D. Clarification

D. Clarification Clarification verifies the nurse's interpretation of the client's message. None of the other options are associated with the verification of the client's meaning.

After a client discusses a personal relationship with a parent, the nurse asks, "Tell me if I'm correct that you feel dominated and controlled by this person?" What is the purpose of the nurse's question? A. Eliciting more information B. Encouraging evaluation C. Verbalizing the implied D. Clarifying the message

D. Clarifying the message Clarification helps the nurse understand and correctly interpret the client's message. It gives the client the opportunity to correct misconceptions. This is not the purpose of any of the other options.

A key quality indicator that might be identified for successful outcome in a medication education group could be that clients will engage in which activity? A. Stating they respected the leader B. Demonstrating a bond among members of the group C. Describe modes of transmission of sexually transmitted diseases D. Confer with health care provider before changing medication regimen

D. 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. None of the other options are associated with the focus of medication education.

During a therapeutic encounter, the nurse makes an effort to ensure the use of two congruent levels of communication. What is the rationale for this? A. The mental image of a word may not be the same for both nurse and client. B. One statement may simultaneously convey conflicting messages. C. Many of the client's remarks are no more than social phrases. D. Content of messages may be contradicted by process.

D. Content of messages may be contradicted by process. Verbal messages may be contradicted by the nonverbal message that is conveyed. The nonverbal message is usually more consistent with the client's feelings than the verbal message. None of the remaining options are so directly associated with assuring congruency.

In order to be most effective, the community mental health nurse involved in assertive community treatment (ACT) needs to possess which characteristic? A. Knowledge of both national and local political activism B. The ability to cross service systems C. An awareness of own cultural and personal values D. Creative problem-solving and intervention skills

D. Creative problem-solving and intervention skills Creative problem-solving and intervention skills are the hallmark of care provided by the ACT team.

The outcome of the nurse's expressions of sympathy instead of empathy toward the client often leads to which outcome? A. Enhanced client coping B. Lessening of client emotional pain C. Increased hope for client improvement D. Decreased client communication

D. Decreased client communication Sympathy and the resulting projection of the nurse's feelings limit the client's opportunity to further discuss the problem. The remaining options are positive outcomes.

A recent immigrant to the United States from which country would tend to display little facial emotion when dealing with emotional stress? A. Korea B. Mexico C. Japan D. Germany

D. Germany German and British individuals also tend to highly value the concept of self-control and may show little facial emotion in the presence of great distress or emotional turmoil.

A client has been diagnosed with acute anxiety attacks. Which herbal remedy should the nurse caution the client to avoid because of its potential to damage the liver? A. Golden root B. Valerian Root C. Lavender D. Kava

D. 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. This is not a known risk associated with any of the other options.

The advanced practice nurse running a group on the adolescent unit makes no attempt to control the topic and makes no comment unless asked a direct question. What leadership style is the nurse implementing? A. Autocratic B. Authoritarian C. Democratic D. Laissez-faire

D. 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 do not allow for much interaction. Authoritarian is another word for autocratic. A democratic leader involves the group members in decision making.

What function is shared by advanced practice and general practice psychiatric nurses? A. Prescriptive authority B. Admitting privileges C. Offers consultation services D. Membership on a multidisciplinary team

D. Membership on a multidisciplinary team Nurses at both levels are expected to collaborate with multidisciplinary teams; only the advanced practice nurse has prescriptive authority and admitting privileges and can provide consultation.

Which situation demonstrates the nurse functioning in the role of advocate? A. Providing one-to-one supervision for a client on suicide precautions B. Co-leading a medication education group for clients and families C. Attending an in-service education program to obtain recertification in cardiopulmonary resuscitation D. Negotiating with the client's HMO for extension of a 3-day hospitalization to 5 days

D. Negotiating with the client's HMO for extension of a 3-day hospitalization to 5 days In the inpatient setting, case managers on the hospital team communicate daily or weekly with the client's insurer and provide the treatment team guidance regarding the availability of resources. In the community, multiple levels of intervention are available within case management service, ranging from daily assistance with medications to ongoing resolution of housing and financial issues.

A client tells the nurse "I really feel close to you. You are like the friend I never had." The nurse can assess this statement as indicating the client may be experiencing which unconscious emotion? A. Congruence B. Empathetic feelings C. Countertransference D. Positive transference

D. Positive transference Transference involves the client experiencing feelings toward a nurse that belong to a significant person in the client's past. If a patient is motivated to work with you, completes assignments between sessions, and shares feelings openly, it is likely the patient is experiencing positive transference. The behavior is not associated with any of the other options.

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 what activity? A. Group content B. Confrontation C. Subgrouping D. Providing feedback

D. Providing feedback Feedback includes letting the group know how they and the comments made in group make the individual feel. This form of sharing is not associated with any of the other options.

During a therapeutic encounter the nurse remarks to a client, "I noticed anger in your voice when you spoke of your father. Tell me about that." What communication techniques is the nurse using? A. Giving information and encouraging evaluation B. Presenting reality and encouraging planning C. Clarifying and suggesting collaboration D. Reflecting and exploring

D. Reflecting and exploring Reflecting conveys the nurse's observations of the client when a sensitive issue is being discussed. Exploring seeks to examine a certain idea more fully.

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

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

Which phase of the nurse-client relationship may cause client anxieties to reappear and past losses to be reviewed? A. Preorientation phase B. Orientation phase C. Working phase D. Termination phase

D. Termination phase Termination, a stage in which the client must face the loss or ending of the therapeutic relationship, often reawakens the pain of earlier losses. This is not generally associated with the other phases.

It is not always guaranteed that all clients who are voluntarily admitted to a behavioral health unit will have the right to which privilege? A.Refusal of treatment. B. To send and receive mail. C. To seek legal counsel. D. To access all personal possessions.

D. To access all personal possessions. A client has the right to keep personal belongings unless they are dangerous. Items such as sharp objects, glass containers, and medication are usually removed from the client's possession and kept in a locked area to be used by the client under supervision or returned at discharge. The remaining options are civil rights afforded to all clients.

Which assessment should the nurse perform to evaluate the pharmacokinetic effect of a monoamine oxidase inhibitors (MAOIs) antidepressant medication? 1. The status of the client's appetite 2. The results of the liver function test 3. The level of depression exhibited by the client 4. The client's current sleeping patterns

2. The results of the liver function test Pharmacokinetics refers to the movement of a drug through the body. Four basic processes of pharmacokinetics which determine the concentration of a drug at its sites of action are easily remembered with the acronym ADME: absorption, distribution, metabolism, and excretion. MAOIs can affect liver function and require monitoring. The other options are related to the medication's pharmacodynamic effects.

What assumption can be made about the client who has been admitted on an involuntary basis? (Select all that apply.) A. The client can be discharged from the unit on demand of next of kin. B. For the first 48 hours, the client can be given medication over objection. C. The client has failed to agree to fully participate in treatment and care planning. D. The client is a danger to self or others or unable to meet basic needs. E. The commitment was court ordered.

C. The client has failed to agree to fully participate in treatment and care planning. D. The client is a danger to self or others or unable to meet basic needs. E. The commitment was court ordered. Involuntary admission which is court ordered implies that the client did not consent to the admission. The usual reasons for admitting a client over his or her objection is if the client presents a clear danger to self or others or is unable to meet even basic needs independently. Neither of the remaining options is accurate assumption regarding an involuntary admission.

The primary goal and benefit of assertive community treatment (ACT) is demonstrated by which situation? A. A client and family members attend counseling sessions together at a neighborhood clinic B. Implementation of a more flexible work schedule for staff C. Improved reimbursement for services provided in the community D. A client diagnosed with schizophrenia has avoided being rehospitalization for 16 months.

D. A client diagnosed with schizophrenia has avoided being rehospitalization for 16 months. A primary goal of ACT is working intensely with the client in the community to prevent rehospitalization. The other options are not goals of ACT.

What term is used to describe a deviation from expectations by members of the cultural group? A. Hostility B. Lack of self-will C. Variation from tradition D. Illness

D. Illness Deviation from cultural expectations is considered by others in the culture to be a problem and is frequently defined by the cultural group as "illness." None of the other terms are used to describe this concept.