Chapter 9,10,11,12

Which of the following clients would most likely be mandated outpatient treatment?

A client who is addicted to alcohol who has two DUI offenses

An adult client is put in restraints after all other attempts to reduce aggression have failed. Which of the following is required now that restraints have been instituted?

A face-to-face evaluation by a licensed independent practitioner within 1 hour of restraint.

Which of the following client situations most urgently requires the nurse to break confidentiality and warn a third party?

A jealous man states, I am getting my gun and going to shoot my wife's lover!

Which of the following are common characteristics of violent families regardless of the type of abuse that exists? Select all that apply.

A) Abuse of power and control B) Alcohol and other drug abuse C) Intergenerational transmission D) Social isolation

Which of the following are critical components in assessment of a person's grief? Select all that apply.

A) Adequate perception regarding the loss C) Adequate support while grieving for the loss E) Adequate coping behaviors during the process

Anger management is likely to be included in the care of clients with which of the following psychiatric diagnoses? Select all that apply.

A) Alzheimer's dementia B) Schizophrenia D) Acute alcohol intoxication

Which of the following statements about anger, hostility and aggression are accurate? Select all that apply

A) Anger is an emotional response to a real or perceived provocation. C) Physical aggression involves harming other persons or property E) Hostility is also referred to as verbal aggression

The term standards of care refers to expectations of nursing performance. Standards of care are developed from which of the following? Select all that apply.

A) Code of Ethics for Nurses with Interpretive Statements C) State Nurse Practice Acts D) Agency job descriptions E) Professional nursing organizations

The nurse is caring for a hospice client whose death is imminent. In preparing the family for the death of their loved one, then nurse prepares to assist the family in which of the following, regardless of the family's cultural preferences? Select all that apply.

A) Dealing with the shock of losing a loved one C) Efforts to stay connected to the client after death E) Anger at the loss of a loved one

Under which conditions would it be in the client's best interest for the court to appoint a conservator, or legal guardian? Select all that apply.

A) Gravely disabled B) Mentally incompetent D) Unable to provide basic needs when resources exist

Which of the following are important issues for nurses to be aware of when working with angry, hostile, or aggressive clients? Select all that apply

A) Nurses must be aware of their own feelings about anger and their use of assertive communication and conflict resolution. D) Nurses must discuss situations or the care of potentially aggressive clients with experienced nurses. E) Nurses must be calm, nonjudgmental, and nonpunitive when using techniques to control a client's aggressive behavior.

. Which of the following interventions are most effective in managing the environment to reduce or eliminate aggressive behavior? Select all that apply

A) Planning group activities such as playing games B) Scheduling one-to-one interactions with the client C) Providing structure and consistency in the unit

The nurse is collecting assessment data on a client who is suspected to be a victim of violence. Which assessment data would support the suspicion that the client is a victim of abuse? Select all that apply.

A) The client has few friends D) There is a moderate amount of alcohol use in the home. E) The client reports that the father was abusive during childhood

Which of the following are criteria that must be adhered to when instituting the short term use of restraint or seclusion? Select all that apply.

A) The client is aggressive. C) The client is imminently dangerous to himself or herself or to others. E) All other means of calming the client have been unsuccessful.

Which of the following persons are most likely experiencing complicated grieving? Select all that apply.

A) The spouse of a person who died 7 years ago and visits the grave several times a day C) A driver whose spouse and children all died as a result of his driving drunk. D) An adult who insisted for many years that he or she hated his or her deceased parent. E) The parent of a child who died after the having left the child in a car on a hot day.

Which of the following are eventual outcomes of the emotional dimension of grieving? Select all that apply.

A) The survivor begins to reestablish a sense of personal identity, direction, and purpose for living. B) The survivor begins to gain independence and confidence. C) The survivor develops new ways of managing life and new relationships.

Which of the following would be circumstances when a client could be subjected to involuntary hospitalization? Select all that apply

A) When a client states that he or she intends to commit suicide and is making plans to do so. C) When a client states that he or she intends to harm others by a deliberate act. E) When a client is unable to control his or her rage and is assaulting everyone around him or her

Which of the following dilemmas involve the ethical principle of fidelity? Select all that apply.

A) When the nurse is unable to agree with the policies or common practices of an agency B) When the nurse is faced with a decision to violate a policy that is harmful to the client

The physician has prescribed Haldol 10 mg for a severely psychotic client. The client refuses the medication. Which nursing intervention is an appropriate response?

Accept the client's decision

Kubler-Ross developed a model of five stages to explain what people experience as they grieve and mourn. Which is stage V of Kubler-Ross's stages of grieving?

Acceptance

What a culture considers acceptable strongly influences the expression of anger. Which culture-bound syndrome is a dissociative episode characterized by a period of brooding followed by an outburst of violent, aggressive, or homicidal behavior directed at other people and objects?

Amok

Which one of the following statements about anger is most accurate?

Anger awareness and expression are necessary for women's growth and development

A nurse is working with a client who has frequent angry outbursts. Which of the following statements is most helpful when working with this client?

Anger is a normal feeling, and you can use it to solve problems.

The most effective way for the nurse to provide culturally competent care to individuals who are grieving is which of the following?

Ask the client what rituals are personally meaningful.

An angry client has just thrown a chair across the room and is racing to pick up another chair to throw. The most appropriate action by the nurse would be which of the following?

Call for an emergency response from trained personnel.

A nurse is performing safety assessments on a client in mechanical restrains as required by policy. Which action by the nurse demonstrates the ethical principle of nonmaleficence?

Assuring that the restraints are not causing injury to the client

A nurse is questioning whether it is ethical to seclude a client because of loud and intrusive behavior on the unit. What is the ethical principle that will best guide the decision on appropriate use of seclusion?

Autonomy

Ensuring that the client has informed consent before agreeing to a treatment regimen displays which of the following ethical principles?

Autonomy

Which of the following losses are likely to result in disenfranchised grief? Select all that apply.

B) A family whose long-time pet snake has just died C) A nurse who has just witnessed the death of a patient D) A couple who has just experienced pregnancy loss E) The gay lover of a man who just died from AIDS

Which of the following are critical components to assess in a grieving person? Select all that apply

B) Perception of the loss C) Support system D) Coping behaviors

A married couple has just received the news that the husband has terminal cancer. The wife tells the nurse, Maybe if we get another opinion and start treatment right way there is a chance of survival. The nurse documents that the wife is expressing signs of which of Kubler-Ross's stages of grief?

Bargaining

The client says to the nurse, I really want to see my first grandchild born before I die. Is that too much to ask? The nurse would recognize that the client is in which stage of grieving, according to Kubler-Ross?

Bargaining

A client underwent a procedure before the nurse verified the client's signature on the consent form. The client actually did not sign the form before the procedure. If the client is dissatisfied with the outcome of the procedure and files a suit against the health-care team, which kind of case can the client file?

Battery

Which of the following terms is used to describe the process by which a person experiences the grief?

Bereavement

When interacting with a client in the day room, the nurse determines that a violent outburst is imminent. Which of the following should the nurse do first?

Call for assistance.

The nurse decides to place an aggressive and violent client in mechanical restraints. The nurse bases this decision on which of the following?

Client's safety

A client who has depression is admitted to treatment on a voluntary basis. While in the hospital, the client makes several comments about wanting to end it all. The client decides one day to leave against medical advice. Which of the following would be the most appropriate action by the nursing staff?

Contacting the psychiatrist for initiation of commitment proceedings

At which point in the stages of aggressive incidents is intervention least likely to be effective in preventing physically aggressive behavior?

Crisis

After being laid off from work, a client becomes increasingly withdrawn and fatigued, spends entire days in bed, is unkempt, and is eating and sleeping poorly. The nurse would recognize that the client is in which stage of grieving, according to Kubler-Ross?

Depression

Which psychiatric disorder makes a person most susceptible to anger attacks that do not result in physical aggression?

Depression

A woman has just had a therapeutic abortion to end an unintended pregnancy. Afterward, the woman cries because although she wanted to have children in future years, this pregnancy was not well-timed. Which type of grief is this woman most likely to experience?

Disenfranchised grief

Which of the following is most important to maintain therapeutic boundaries when working with aggressive clients?

Do not personalize a client's anger

Which of the following interventions would assist the client with the appropriate expression of anger?

Encourage verbalization

. The nurse observes two clients in the day room arguing. One client runs into the corner and huddles while the other follows and continues with verbal abuse. Which is the best action by the nurse?

Engage the attention of the client who is still yelling and ask what is happening.

In the psychiatric setting, what is the most effective intervention in preventing the hostile client's behavior from escalating to physical aggression?

Engaging the hostile person in dialogue

A client is observed pacing the hall with clenched fists and swearing at others. The nurse intervenes immediately to prevent the client from moving to which phase of the aggressing cycle?

Escalation

The client's son is yelling and is hitting his hand with a rolled up newspaper. Which stage of aggression does the nurse identify that the client's son is exhibiting?

Escalation

. Which one of the following is the most common reason for ethical dilemmas being a challenge to nurses?

Ethical dilemmas are often charged with emotion.

The nurse is interviewing a client with a history of physical aggression. Which of the following should the nurse avoid?

Explaining the consequences the client will face if control is lost

The nurse is meeting a client for the first time who has just spontaneously lost her unborn child. After establishing rapport, the priority nursing intervention should focus on which of the following?

Exploring what this loss means for the client

Which of the following is the best explanation for why family violence tends to occur over multiple generations of families?

Family violence may be perpetuated between generations of families by role modeling and social learning

Which of the following statements about the crisis phase of aggression when the client becomes physically aggressive is true?

Four to six trained staff members are needed to restrain.

. The client identifies anger management as a problem. What is the next step in planning therapeutic interactions?

Give the client permission to be angry

A client was brought to the emergency department by police after neighbors complained that he was loud and disruptive. The client is paranoid and upset and states, No one can be trusted. Which of the criteria for involuntary admission does this client meet?

He does not meet any of the necessary criteria

The nurse is working with a client who lost her youngest child 2 months ago. When the nurse approaches, the client, the client yells, I don't want to talk to you. You have no idea what it's like to lose a child! The nurse bases her response to the client on the understanding of which of the following?

Hostility is a common behavioral response to grief

A woman has just been served divorce papers from her husband. She has no financial resources and little social support. She states, He's not really leaving. He'll be back. The most appropriate response by the nurse would be which of the following?

How is this affecting you right now?

A client approaches the nurse and loudly states, I'm not putting up with this anymore! The most appropriate response by the nurse would be which of the following?

I can see you are angry. Tell me what's going on.

The nurse on an addictive disorders unit receives a phone call inquiring about the status of a client. The caller is not on the client's allowed contact list. Which of the following is the appropriate response by the nurse to the caller?

I cannot confirm or deny the existence of any client here.

A married man expresses to the nurse that his wife's frequent nagging angers him. The nurse role-plays assertive communication techniques with the husband. Which of the following indicates the husband understands how to use assertive techniques effectively?

I feel unappreciated when you criticize me.

A young client tells the nurse that her husband died 3 months ago, and she is feeling alone and vulnerable. Which statement by the client would indicate that her coping skills are adequate?

I will find a support group.

Two nurses are discussing the rights of hospitalized psychiatric clients. Which of the following statements is an error?

If a committed client is also found to be incompetent, he loses his rights under the Patient's Bill of Rights.

When is a nurse legally obligated to breach confidentiality?

If threats are made to an identifiable third party

An elderly woman who lives alone is beginning to have difficulty maintaining her household and performing daily tasks. The nurse asks her to identify someone who can help her. The woman replies, I don't need help. I've been managing for years. Which of the following responses helps the client shift from denial to consciously coping with her situation?

If you were to need help with your house, who might you ask for help?

The nurse is conducting a history and physical exam on a client who is grieving the unwanted loss of a marriage by divorce. Which of the following physical symptoms of grief would the nurse most likely expect to detect in the history?

Insomnia

A young couple just ended their relationship after a 9-month engagement. The one of the individuals is seeking short-term counseling to assist in grieving this loss. Which type of loss best describes what this client is experiencing?

Loss of security and sense of belonging

The staff on an inpatient psychiatric unit is very busy and fall behind on periodic assessment of a severely depressed client. During the rounds, the client is discovered to have completed a suicide attempt in the bathroom. Which type of lawsuit could the client's family file?

Malpractice

The nurse is attending an in-service training on safe take-down techniques for aggressive clients. Preparation for safe physical handling prepares the nurse to practice which ethical principle?

Nonmaleficence

Which of the following is most likely to prevent the client from experiencing complicated grief?

Places trusts familiar others

A nurse has been caring for a gunshot victim who has just died. Various family and friends are present. One of the visitors privately discloses to the nurse that she and the client were having an illicit affair. Which of the following is the best action by the nurse after learning of this relationship?

Privately offer support to the visitor who was having the affair with the client

Placing a client in restraints before using other methods of intervention violates which of the client's rights?

Receive treatment in the least restrictive environment

One of the first steps that a nurse should take to deal effectively with aggressive clients is which of the following?

Reflect on abilities to handle own feelings of anger

The nurse is teaching a client to recognize early signs of anger and aggression. The nurse explores ways that the client can recognize which of the following?

Restlessness and irritability

A client made threats to harm his parents if they come too close to him. The parents called 911, and the client is now held involuntarily for a psychiatric evaluation. During this time of involuntary admission, the client retains all client rights except for which of the following?

Right to freedom

A child who has witnessed the murder of his classmate while at school would experience which kind of loss?

Safety loss

A young female immigrant presents in the rural health clinic with facial bruising and a fractured nose. The client is reluctant to give details of the nature of her injuries. Which of the following should be a consideration in providing care for this client?

She may fear deportation if she seeks public assistance

A client is clenching his fists and yelling at another client on the unit. He appears to be close to losing control of his anger. Which of the following actions by the nurse is appropriate at this time?

Tell the client to stop and take a time-out

A client who is depressed and suicidal is scheduled for electroconvulsive therapy (ECT), which requires consent. Legally, who should sign the consent for this treatment?

The client

Which is most likely to be the subject of an aggressive attack from a client with mental illness?

The client

A client with terminal cancer has been told he has 3 or 4 months to live. Which of the following would indicate to the nurse that further interventions are needed?

The client says he is well and is making future plans

The nurse is establishing outcomes for a grieving client. Which of the following is an appropriate outcome?

The client will develop a plan for coping with the loss.

A client comes to the physician's office for an annual checkup. During the interview, the nurse learns that the client's husband died unexpectedly of a heart attack 2 months ago. The most appropriate response by the nurse would be,

The loss of your husband must be very painful for you.

A malpractice lawsuit was filed after a nurse restrained the client for screaming at and attempting to strike anyone who was within striking distance. The nurse followed agency procedures that were consistent with Joint Commission Standards. For which reason is this malpractice lawsuit most likely to be unsuccessful?

The nurse did not breach duty.

A client lost control of his behavior, broke a window, and made verbal threats to staff and other clients. The client was placed in mechanical restraints. Which statement should the nurse make to explain the use of restraints to the client?

This is a means of keeping you and others safe.

A client who has been physically aggressive arrives at the emergency room for a psychiatric assessment. Which would be the best approach for the nurse to use?

Use brief statements and questions to obtain information.

A client being served in a busy inpatient psychiatric unit becomes very noisy and combative. The other clients are complaining about the noise and are afraid that they will be hurt by the client. The nurse determines that the best course of action for all involved is to seclude the client until the client is able to regain control of his behavior. On which ethical principle did the nurse base this decision?

Utilitarianism

After an angry outburst, the client is tearful and remorseful. Which statement by the nurse would be most supportive?

What could you have done when you first started to feel angry?

After an angry outburst, a client quickly appears more calm and rational. The nurse approaches the client. Which of the following is the most helpful response to the client at this time?

What happened that got you so upset?

Friends of a teenage male recently killed in a car accident are discussing their sense of loss. Which of the following comments best indicates that the friends are trying to make sense of the loss cognitively?

Why did he have to die so young?

A client who has been grieving the loss of his wife 2 weeks ago says to the nurse, The best part of my day is when I am back at work. Is that wrong? The nurse educates that work and other daily activities serve which purpose?

Working is letting you take an emotional break from grieving. There's nothing wrong with that.

A woman has just delivered a stillborn baby boy. Which of the following would be the most appropriate nursing response?

Would you like to hold your son?

The nurse is working with a woman who lost her partner nearly 3 weeks prior. The woman has recently become less emotional and expressed that few things in her life have meaning right now. Which response by the nurse is most appropriate at this time?

You are just starting to accept that this loss is real

The nurse approaches a client who looks very sad and is sitting alone crying. The best response by the nurse in this situation is,

You look very sad. What is happening?

A client suddenly jumps up from the chair and begins yelling and cursing at the nurse. Which would be the best response by the nurse?

You seem angry. Tell me more about how you're feeling.

Disclosure of client information beyond the interdisciplinary team without consent of the client is a breach of

confidentiality

A 22-year-old client has been manipulative of staff and disruptive in the milieu. Although she is not dangerous to herself or others, she has created problems on the unit and clearly is not making progress. The nurses offer prescribed medication, but she consistently refuses any drugs. The staff realizes that legally this client can

continue to refuse treatment.

A client who had agreed to be hospitalized for depression problems has decided that now she wants to leave the hospital. The mental health staff caring for her realizes that at present she can legally

leave the hospital after giving written notice of her intent to do so.

An adolescent on the unit is argumentative with staff and peers. The nurse tells the adolescent, Arguing is not allowed. One more word and you will have to stay in your room the rest of the day. The nurse's directive is

inappropriate; room restriction is not treatment in the least restrictive environment

. A couple came to the emergency department with their 5-month-old son. He was pronounced dead of sudden infant death syndrome (SIDS). In the next day or two, it will be important for this couple to

plan funeral arrangements for their son.

The client with a history of explosive outbursts becomes angry and states, I am really getting angry. The nurse sees this as

progress.

A client is scheduled for a mastectomy for breast cancer. She is quiet, shows little emotion, and states that she has no questions. The nurse's assessment would need to focus on

the meaning of the mastectomy to the client.