Evolve EAQ: Psych- Foundations and Modes of Care

When planning nursing care for clients who are grieving the potential death of a family member, it is helpful to draw on the understanding of the five stages of grieving identified and described by Elisabeth Kübler-Ross. Place these stages in order of progression from first to last. 1. Anger 2. Denial 3. Depression 4. Acceptance 5. Bargaining

1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance Initially when someone is coping with grief there is a refusal to believe that the loss has occurred or is going to occur (denial), and individuals are in a state of shock. As awareness of the loss increases, people usually become angry and cannot understand why this is happening. Coping then moves into the stage of bargaining, in which the dying or grieving person attempts to avoid the loss by gaining more time. This is followed by depression, when what has happened becomes undeniable. Finally individuals may progress to the stage of acceptance after coming to terms with the loss.

A nurse is caring for a client who has been experiencing delusions. According to psychodynamic theory, what are delusions? A. A defense against anxiety B. The result of magical thinking C. Precipitated by external stimuli D. Subconscious expressions of anger

A. A defense against anxiety Delusions are a way the unconscious defends the individual from real or imagined threats. Magical thinking is the belief that one's thoughts and behaviors can control situations and other people. For example, having bad thoughts about someone can cause that person to die. This type of thinking is found in young children but is pathological in adults. Illusions are false interpretations of actual external stimuli. Delusions are precipitated by feelings of anxiety, not anger.

The parents of an autistic child begin family therapy with a nurse therapist. The father states that the family members wish to share their religious beliefs with the therapist. What should the nurse do? A. Limit the father's discussion of religion B. Include the mutual discussion of religious beliefs C. Invite the family's religious leader to a therapy session D. Encourage family discussion of their religion in the sessions

4. Encourage family discussion of their religion in the sessions If religious beliefs are a family concern, the nurse should allow discussion of the family's thoughts and feelings on the subject; the discussion should be encouraged, not limited. The role of the nurse is to facilitate and listen, not to participate in a mutual discussion about religious beliefs. The religious leader is not part of the family unit and should be invited only if this is requested by the family.

An inpatient therapy group on a psychiatric unit has as its goal helping clients participate in life more fully by gaining insight and changing behavior. The nurse leader can best help the group achieve this goal by using a leadership style that is what? A. Democratic and guiding B. Autocratic and directing C. Laissez-faire and observing D. Passive and nonconfrontational

A. Democratic and guiding A democratic and guiding leader stimulates and directs the group to assist it in developing its maximal potential by facilitating and balancing the group's forces. An autocratic and directing leader makes most of the decisions and controls the group, thereby limiting group growth potential. A laissez-faire, observing leader allows group members to take over the group; if there are no members with leadership skills, little is gained from the group. A passive and nonconfrontational leader does not provide adequate leadership to make the group effective.

A nurse is conducting a therapy group whose objectives are to assist the members to gain insight and to change behavior so they are able to participate in life in a more satisfying manner. What leadership style will best help the nurse achieve these objectives? A. Democratic, guiding B. Hierarchal, directing C. Autocratic, controlling D. Laissez-faire, observing

A. Democratic, guiding A democratic, guiding type of leader stimulates, directs, and assists the group to develop its maximum potential by facilitating and balancing group forces. A hierarchal, directing type of leader makes most of the decisions and controls the group, thus limiting group growth potential. An autocratic, controlling type of leader makes most of the decisions and controls the group, thus limiting group growth potential. A laissez-faire, observing type of leader allows group members to take over the group; if the group has no leader or leaders, little is gained from the group.

Fourteen months after the traumatic death of a spouse, a client comes to the mental health clinic complaining of continuing depression and states, "I haven't been seeing any of my friends or attending any of the activities I previously enjoyed. My children are married and live in another state, and I almost never see them." What does the nurse determine that the client is experiencing? A. Difficulty grieving B. Ineffective family interactions C. Problems in communicating with others D. Low motivation to resume daily activities

A. Difficulty grieving The client's grieving process is severe and extended, indicating dysfunction. There are not enough data to support the conclusion that the family's interactions are ineffective. The data do not indicate problems with communication; the client is communicating effectively with the nurse. Low motivation is not the reason for the client's inability to cope.

What is the priority when the nurse is establishing a therapeutic environment for a client? A. Ensuring the client's safety B. Accepting the client's individuality C. Promoting the client's independence D. Explaining to the client what is being done

A. Ensuring the client's safety Safety is the priority before any other intervention is provided. Accepting the client's individuality, promoting the client's independence, and explaining to the client what is being done are all important, but less of a priority.

The nurse is planning therapeutic group sessions for regressed long-term clients. The nurse understands that these clients need to do what? A. Experience a structured setting B. Learn how to confront interpersonal conflict C. Develop the sense that they can control the group D. Have opportunities for an expression of deep feelings

A. Experience a structured setting Regressed long-term clients need structure and external controls to help organize their thought processes. These clients need gentle assistance to deal with conflict situations. Most regressed long-term clients would be too anxious to assume a leadership role. Such experiences are beyond the capability or psychological tolerance of these clients.

A mother whose child has been killed in a school bus accident tells the nurse that her child was just getting over the chickenpox and did not want to go to school but she insisted that the child go. The mother cries bitterly and says that her child's death is her fault. The nurse understands that perceiving a death as preventable mostoften will influence the grieving process in that it may do what? A. Grown in intensity and duration B. Progress to a psychiatric illness C. Be easier to understand and to accept D. Cause the mourner to experience a pathological grief reaction

A. Grow in intensity and duration Deaths that are perceived as preventable cause more guilt for the mourners and therefore increase the intensity and duration of the grieving process. Perceiving a death as preventable will not necessarily result in a pathological reaction, but it will usually make it harder to understand and accept the death.

A nurse is working with children who have been sexually abused by a family member. What overwhelming feelings do these children usually express? Select all that apply. A. Guilt B. Anger C. Revenge D. Disbelief E. Self-blame

A. Guilt B. Anger E. Self-blame Sexually abused children often have nonsexual needs met by their abuser and are powerless to refuse; ambivalence results in self-blame and guilt. Anger may exist, especially toward the nonabusive parent who is not protecting the child. Disbelief or a desire for revenge may exist, but neither is the overwhelming feeling reported.

A psychiatric nurse is hired to work in the psychiatric emergency department of a large teaching hospital. While reviewing the manuals, the nurse reads, "People with mental health emergencies shall be triaged within 5 minutes of entering the emergency department." What does the nurse consider this statement to represent? A. Hospital policy B. Standard of care C. Hospital procedure D. Mental Health Bill of Rights

A. Hospital policy Policies are statements that help define a course of action; what is to be done is stated in policies, and how a task or skill is to be performed is defined in a procedure manual. Standards of care are published by the American Nurses Association; they reflect current knowledge and represent levels of practice agreed on by experts within the specialty; in legal terms, the standard of care is that level of practice that a reasonably prudent nurse would provide. A hospital procedure defines how a task or skill is to be performed. The Mental Health Bill of Rights states that all clients have the right to respectful care, confidentiality, continuity of care, relevant information, and refusal of treatment, except in an emergency or by law.

Which statement best describes the practice of psychiatric nursing? A. It helps people with existing or potential mental health problems B. It ensures clients' legal and ethical rights by serving as client advocate C. It is therapeutic for people in whom mental disorders have been diagnosed D. It focuses interpersonal skills on people with pysical or emotional problems

A. It helps people with existing or potential mental health problems Primary, secondary, and tertiary interventions to promote emotional equilibrium constitute an important aspect of the role of the psychiatric nurse. Acting in a therapeutic manner with people with diagnosed mental disorders is only a part of the role of the psychiatric nurse; psychiatry is concerned with people with varying degrees of mental and emotional disorders. Ensuring clients' legal and ethical rights and focusing interpersonal skills on people with physical or emotional problems are only small parts of the role of the psychiatric nurse and are usually shared with other members of the health care team.

A nurse is assigned to lead a relaxation group. Which techniques should the nurse incorporate? Select all that apply. A. Meditation B. Mental imagery C. Token economy D. Operant conditioning E. Deep-breathing exercises

A. Meditation B. Mental Imagery E. Deep-breathing exercises Meditation lowers heart and blood pressure rates, decreases levels of adrenal corticosteroids, improves mental alertness, and increases a sense of calmness and peace. Imagery is the internal experience of memories, dreams, fantasies, and visions that serves as a bridge connecting the body, mind, and spirit; its distractive ability decreases adrenal corticosteroids, promotes muscle relaxation, and increases a sense of calmness and peace. Deep breathing increases oxygenation and releases tension in the muscles of the neck, shoulders, and torso. Token economy is a behavioral theory that acknowledges acceptable behavior with a reward (token) that can be redeemed for something that has a perceived value (e.g., a desirable activity). Operant conditioning, a behavioral therapy, is the learning of a particular type of behavior followed by a reward.

A 13-year-old who recently was suspended from school for consistently bullying other children is brought to the pediatric mental health clinic by his mother. The child is assessed by the psychiatrist and referred to a psychologist for further testing. The day after the tests are completed, the mother returns to the clinic and asks the nurse for results of the tests. Which is the best response by the nurse? A. Refer the mother to the psychiatrist B. Explain to the mother the results of the tests C. Suggest that the mother call the psychologist D. Teach the mother about the tests that were administered

A. Refer the mother to the psychiatrist It is the responsibility of the psychiatrist, who is the primary healthcare provider, to discuss the test results with the mother. Explaining to the mother the results of the tests is beyond the scope of the nurse's role. The mother should be referred to the psychiatrist, not the psychologist, because the psychiatrist is the leader of this health team. Teaching about the tests should have been done before, not after, the tests were administered. It is important that this student get the testing and counseling needed since the future problems of bullies include a higher risk for conduct problems, hyperactivity, school dropout, unemployment, and participation in criminal behavior. Chronic bullies seem to continue their behaviors into adulthood, negatively influencing their ability to develop and maintain relationships.

A nurse is working with a child who was physically abused by a parent. What is the most important goal for this family? A. The child will live in a safe environment B. The parents will use verbal discipline effectively C. The family will feel comfortable in its relationship with the counselor D. The parents will gain an understanding of their abusive behavior patterns

A. The child will live in a safe environment The most important goal and top priority is to ensure the safety of the child. Once this is ensured, other goals can be identified and fulfilled, including the parents using verbal discipline effectively, the family feeling comfortable in its relationship with the counselor, and the parents gaining an understanding of their abusive behavior patterns.

What is the most important tool a nurse brings to the therapeutic nurse-client relationship? A. The self and a desire to help B. Knowledge of psychopathology C. Advanced communication skills D. Years of experience in psychiatric nursing

A. The self and a desire to help The nurse brings to a therapeutic relationship the understanding of self and basic principles of therapeutic communication; this is the unique aspect of the helping relationship. Knowledge of psychopathology, advanced communication skills, and years of experience in the field all support the psychotherapeutic management model, but none is the most important tool used by the nurse in a therapeutic relationship.

What is the best initial approach to take with a self-accusatory, guilt-ridden client? A. Contradict the client's persecutory delusions B. Accept the client's statements as the client's beliefs C. Medicate the client when these thoughts are expressed D. Redirect the client whenever a negative topic is mentioned

B. Accept the client's statement as the client's beliefs The nurse must accept the client's statement and beliefs as real to the client to develop trust and move into a therapeutic relationship. Clients cannot be argued out of delusions. Medication should not be the initial approach. Redirecting the client's conversation whenever negative topics are brought up may make the client believe that these thoughts and feelings are being ignored.

A 68-year-old client who has metastatic carcinoma is told by the practitioner that death will occur within a month or two. Later the nurse enters the client's room and finds the client crying. Before responding, which factor should the nurse consider? A. Crying relieves depression and helps the client face reality B. Crying releases tension and frees psychic energy for coping C. Nurses should not interfere with a client's behavior and defenses D. Accepting a client's tears maintains and strengthens the nurse-client bond

B. Crying releases tension and frees psychic energy for coping Crying is an expression of an emotion that, if not expressed, increases anxiety and tension; the increased anxiety and tension use additional psychic energy and hinder coping. Crying does not relieve depression, nor does it help a client face reality. It is not universally true that nurses should not interfere with a client's behavior and defenses. In most instances the client's defenses should not be taken away until they can be replaced by more healthy defenses. The nurse must interfere with behavior and defenses that may place the client in danger, but the client's current behavior poses no threat to the client. It is not always true that accepting a client's crying maintains and strengthens the nurse-client bond. Many clients are embarrassed by what they consider a "show of weakness" and have difficulty relating to the individual who witnessed it. The nurse must do more than just accept the crying to strengthen the nurse-client relationship.

An Asian client arrives at the mental health clinic with symptoms of anxiety and panic. While speaking with the client, the nurse notes that the client makes very little eye contact. What does this assessment data suggest? A. Shyness B. Cultural variation C. Symptom of depression D. Shame regarding treatment

B. Cultural variation As a show of respect, people in Asian cultures tend to make little eye contact, particularly with people perceived as authority figures. A lack of eye contact may connote shyness in some clients, but further assessment is needed. A lack of eye contact may suggest a depressed mood; however, there is no indication of depression in this client. A lack of eye contact may indicate shame or low self-esteem in the American culture; however, it is important not to make this same interpretation of behavior for someone from another culture.

An older adult with a chronic degenerative disease progresses to the stage at which self-care is no longer possible, and admission to a long-term care facility becomes necessary. What is the major developmental conflict for this client, according to Erikson? A. Intimacy versus isolation B. Ego integrity versus despair C. Identity versus role diffusion D. Generativity versus stagnation

B. Ego integrity versus despair The need for acceptance of life as fulfilling and meaningful is the major task of the older adult. Intimacy versus isolation is the task of young adulthood (18 to 25 years); it involves establishment of an intimate relationship and occupation. The task of the adolescent (12 to 20 years) is establishing identity through work and development of relationships and an occupation. Generativity versus stagnation is the task of adulthood (21 to 45 years); it involves establishment of a family and guidance of the next generation.

What action should the nurse manager take when it becomes apparent that communication between the nurse and the client is consistently superficial? A. Assessing the client's ability to understand the nurse's questions B. Evaluating how actively the nurse has been listening to the client C. Reinforcing to the client how important string is for successful recovery D. Reviewing how the questioning techniques are being used by the client

B. Evaluating how actively the nurse has been listing to the client Effective active listening is critical to the development of meaningful, therapeutic communication between the nurse and the client. A lack of effective listening on the part of the nurse commonly results in superficial, ineffective communication. Although there may be situations in which assessing the client's cognitive abilities, reinforcing the importance of effective communication, or reviewing communication skills is an appropriate intervention, there are other, more commonly observed barriers to effective therapeutic communication.

Which functions are registered nurses legally permitted to perform in a mental health hospital? Select all that apply. A. Psychotherapy B. Health promotion C. Case management D. Prescribing medication E. Treating human responses

B. Health promotion C. Case management E. Treating human responses Health promotion, case management, and treating human responses are all within the legal scope of nursing practice. Registered nurses may use counseling interventions but may not perform psychotherapy; the members of the nursing team permitted to perform psychotherapy are psychiatric/mental health clinical nurse specialists and psychiatric/mental health nurse practitioners. Only those who are legally licensed to prescribe medications, such as psychiatric nurse practitioners, may do so.

A nurse in the mental health clinic concludes that a client is using confabulation when the client does what? A. The flow of thoughts is interrupted B. Imagination is used to fill in memory gaps C. Speech fills from one topic to another with no apparent meaning D. Connections between statements are so loose that only the speaker understands them

B. Imagination is used to fill in memory gaps Using imagination to fill in memory gaps is the definition of confabulation; it is a defense mechanism used by people experiencing memory deficits. Interruption of the flow of thoughts is the definition of thought blocking. Flitting of speech from one topic to another with no apparent meaning is the definition of flight of ideas. The definition of associative looseness is connections between statements so loose that only the speaker understands them.

When a newly admitted client with paranoid ideation tells the nurse about people coming through the doors to commit murder, what should the nurse do? A. Ignore the client's stories B. Listen to what the client is saying C. Explain that no one can get through the door D. Ask for an explanation of where the information was obtained

B. Listen to what the client is saying Listening to what the client is saying demonstrates that the nurse believes that what the client has to say is important; it also encourages verbalization of feelings. Ignoring the client's stories may increase the client's feelings of worthlessness and persecution. Explaining that no one can get through the door will accomplish little; a paranoid individual cannot be talked out of his or her feelings. These are feelings, not information, and they cannot always be explained; asking where the information came from forces the client to further develop the delusional system.

A nurse facilitating a support group of widows and widowers recalls that research indicates that the probability of a spouse having a pathological or morbid grief response will be greater in what case? A. The couple had an ambivalent relationship B. The cause of the spouse's death was suicide C. The relationship between the spouses was satisfying D. There was a long preparatory grief period before the spouse's death

B. The cause of the spouse's death was suicide The survivors of a suicide feel more guilt and bitterness and go through a longer grieving process, and therefore the chances of a pathological grief response are increased. An ambivalent relationship between the spouses may result in a difficult grief response because of guilty feelings but should not cause a morbid grief response. Research documents that the more satisfying the relationship, the more likely that the mourner will establish a new relationship. With a preparatory grief period a person may have the opportunity to work through a part of the grief process before the death and have a shorter mourning period after the death.

During a group therapy session some members accuse another client of intellectualizing to avoid discussing feelings. The client asks whether the nurse agrees with the others. What is the best response by the nurse? A. "It seems that way to me, too." B. "What's your perception of my behavior?" C. "Are you uncomfortable with what you were told?" D."I'd rather not give my personal opinion at this time."

C. "Are you uncomfortable with what you were told?" Asking the confronted client whether he or she is uncomfortable with what he or she is being told will help the client identify behaviors and feelings in a nonthreatening manner. Agreeing with the confronting group members indicates a lack of acceptance of the client. The nurse's behavior is not the issue; the situation should be turned back to the client's behavior. Evasion and refusal to answer will have the psychological effect of removing the nurse from the group.

A parent who is visiting a hospitalized adolescent gets into an argument with the adolescent. Leaving the adolescent's room in tears, the parent meets the nurse and relates the argument, saying, "I can't believe I got so angry that I could have hit my child." What is the most therapeutic response by the nurse? A. "Teenagers really can drive you to distraction." B. "Bring a surprise for the child next time. It'll make you both feel better." C. "Sometimes we find it difficult to live up to our own expectations of ourselves." D. "You can't compare yourself to an abusive parent - after all, you didn't beat your child."

C. "Sometimes we find it difficult to live up to our own expectations of ourselves." The response "Sometimes we find it difficult to live up to our own expectations of ourselves" is the best response because it reflects the feelings being expressed at this time. "Teenagers really can drive you to distraction" avoids the real issue. Telling the parent to bring a surprise for the adolescent on the next visit does not address the real concern; the parent's argument may have been justified, and the child's behavior should not be rewarded. The response "You can't compare yourself to an abusive parent—after all, you didn't beat your child" avoids the issue; the parent may fear that next time control will be lost and abuse will occur.

A client has had repeated hospitalizations for aggressive, violent behavior. While on the mental health service, the client becomes very angry, starts screaming at the nurse, and pounds the table. What is the priority nursing assessment at this time? A. Range of expressed anger B. Extent of orientation to reality C. Degree of control over the behavior D. Determination of whether the anger is justified

C. Degree of control over the behavior Degree of control over the behavior is the most important assessment because it will influence the nurse's intervention. Depending on the extent of the client's control, the nurse may or may not need assistance. It is not the degree of anger but instead the behavior it precipitates that is important to assess. The extent of orientation to reality may or may not influence the ability to control behavior. Anger is always justifiable to the person; the determination of whether the anger is justified will not help the nurse address the client's behavior.

A client is admitted to the emergency department after ingesting a tricyclic antidepressant in an amount 30 times the daily recommended dose. What is the immediate treatment anticipated by the nurse? A. Administration of physostigmine as soon as possible B. Closer monitoring to prevent further suicidal attempts C. Gastric lavage with activated charcoal and support of physiologic function D. Intravenous administration of an anticholinergic in response to changes in vital signs

C. Gastric lavage with activated charcoal and support of physiologic function Gastric lavage with charcoal may help decrease the level of tricyclic antidepressant overdose. Supportive measures such as mechanical ventilation may be needed until the medical crisis passes. Physostigmine salicylate was used in the past to promote improvement in consciousness. Now its use is contraindicated because it can cause bradycardia, asystole, and seizures in clients with tricyclic antidepressant toxicity. Prevention of suicidal behavior is always advantageous; however, in this case immediate emergency intervention is necessary. The acetylcholine level is depressed as a result of the tricyclic antidepressant; anticholinergics are most effective in managing the side effects of antipsychotic and neuroleptic drugs, not tricyclic antidepressant drugs.

An older client who lost a spouse 20 years ago comes to the community health center with a vague list of complaints and a brief life history. The couple's only child died at birth. The client lives alone and is able to perform all the activities of daily living. The client has had an active social life in the past but has outlived many friends and family members. What is an important question for the nurse to ask when taking this client's health history? A. "Are you all alone?" B. "How did your son die?" C. "Do you still miss your spouse?" D. "How do you feel about your life now?"

D. "How do you feel about your life now?" The answer to "How do you feel about your life now?" will provide the nurse with an idea of the client's hopes and frustrations without being threatening or probing. "Are you all alone?" is probing and provides little information for the nurse to use in planning care. "How did your son die?" and "Do you still miss your spouse?" are both probing, disregard the client's present situation, and provide little information for the nurse to use in planning care.

A nurse is teaching a class about child abuse. What defense mechanism most often used by the physically abusive individual should the nurse include? A. Repression B. Manipulation C. Transference D. Displacement

D. Displacement Displacement is a defense mechanism in which one's pent-up feelings toward a threatening person are discharged on those who are less threatening. Repression is the unintentional putting out of the mind unacceptable or troubling thoughts, desires, or experiences. Transference is a mechanism by which affects or emotional tones are shifted from one individual to another; it is unrelated to child abuse. Manipulation is a mechanism by which individuals attempt to manage, control, or use others to suit their own purpose or to gain an advantage; it is unrelated to child abuse.

A young adult is being treated in the emergency department for injuries sustained as a result of physical battering by her partner. On learning that there is a history of such abuse, the nurse plans which tertiary nursing interventions? Select all that apply. A. Contacting family members to provide support B. Discussing the legal ramifications of not pressing charges C. Offering to discuss the abusive behavior with the woman's partner D. Identifying the benefits of attending a support group for battered women E. Providing her with information regarding local domestic violence shelters

D. Identifying the benefits of attending a support group for battered women E. Providing her with information regarding local domestic violence shelters Providing information regarding support groups or local domestic violence shelters does qualify as a tertiary intervention because it is focused on preventing further abuse. Contacting family members should not be done without the consent of the client; it violates the client's confidentiality. Discussing the legal ramifications of not pressing charges against the partner implies pressuring the client to act in a manner that she may not be comfortable engaging in at this point. Offering to discuss the behavior with the partner is not advised because it could worsen tensions and result in additional battering; furthermore, such an intervention is not within the scope of nursing practice.

Which outcome specific to a client with impaired verbal communication related to a psychologic barrier should be documented in the client's clinical record? A. Freedom from injury B. Engaging independently in solitary craft activities C. Identifying the consequences of acting-out behavior D. Interacting appropriately with others in the therapeutic milieu

D. Interacting appropriately with others in the therapeutic milieu Interacting appropriately with others in the therapeutic milieu is an outcome related to the identified problem and is appropriate and measurable. Freedom from injury is not related to the identified problem; this is true for everyone. Engaging independently in solitary craft activities will not encourage verbal communication. Identifying the consequences of acting-out behavior is inappropriate and not related to the identified problem.

The wife of a client who is dying tells the nurse that although she wants to visit her husband daily, she can visit only twice a week because she works and has to take care of the house and their cat and dog. What defense mechanism does the nurse conclude that the client's wife is using? A. Projection B. Sublimation C. Compensation D. Rationalization

D. Rationalization Rationalization is offering a socially acceptable or logical explanation to justify an unacceptable feeling or behavior. Projection is the denial of emotionally unacceptable feelings and the attribution of the traits to another person. Sublimation is the substitution of a socially acceptable behavior for an unacceptable feeling or drive. Compensation is making up for a perceived deficiency by emphasizing another feature perceived as an asset.

A client whose spouse died 2 years ago is brought to the psychiatric unit by a family member, who states that the widowed spouse has no interests, is neglecting personal hygiene, and has become totally isolated. The nurse completes a history and physical examination that verifies the family member's concerns. What is most important for the nurse to explore with the client at this time? A. Feelings about the spouse's death B. The real cause of the depressed behavior C. The relationship with the deceased spouse D. Whether suicide has been considered recently

D. Where suicide has been considered recently. The client is depressed; it is important to know whether the client is considering suicide so the nurse can provide a safe environment and related therapeutic care. Concern for the client's safety takes priority at this time over the client's feelings, the underlying cause of the behavior, or the dynamics of the marital relationship.

A nurse understands that value clarification is a technique useful in therapeutic communication because initially it helps clients do what? A. Become aware of their personal values B. Gain information related to their needs C. Make correct decisions related to their health D. Alter their value system to make them more socially acceptable

A. Become aware of their personal values Value clarification is a technique that reveals individuals' values so the individuals become more aware of them and their effect on others. Gaining information, making correct health decisions, and altering value systems to make them more socially acceptable are not outcomes of value clarification.

The nurse understands that paranoid delusions may be related to which defense mechanism? A. Projection B. Regression C. Repression D. Identification

A. Projection Projection is a mechanism in which inner thoughts and feelings are projected onto the environment, seeming to come from outside the self rather than from within. Regression is the use of a behavioral characteristic appropriate to an earlier level of development. Repression is the involuntary exclusion of painful or conflicting thoughts from awareness. Identification is taking on the thoughts and mannerisms of an individual who is admired or idealized.

According to Erikson, what will an individual who fails to master the maturational crisis of adolescence most often do? A. Rebel at parental orders B. Experience role confusion C. Experience interpersonal isolation D. Become a substance abuser

B. Experience role confusion According to Erikson, adolescents are struggling with identity versus role confusion. Rebellion against parental orders reflects part of the struggle for independence; it does not indicate failure to resolve the conflicts of adolescence. Adolescents tend to be group oriented, not isolated; they struggle to belong, not to escape. Adolescents may experiment with drug and alcohol use, but most of them do not become abusers.

Survivors of a major earthquake are being interviewed on admission to the hospital. The nurse notes that they exhibit a flattened affect, make minimal eye contact, and speak in a monotone. These behaviors are indicative of the defense mechanism known as what? A. Isolation B. Splitting C. Introjection D. Compensation

A. Isolation Isolation is the separation of thought or memory from feeling. Splitting is the polarization of positive and negative feelings. Introjection is the integration of the beliefs and values of another into one's own ego. Compensation is making up for a real or imagined lack in one area by overemphasizing another.

A cognitively impaired older adult is brought to the emergency department for treatment of a cut on the forehead. Based on the following assessment information, the nurse concludes that the individual's priority need is what? A. Adequate fluid to prevent dehydration B. Assessment for possible physical abuse C. Nutrition adequate to prevent weight loss D. Implementation of fall-prevention interventions

B. Assessment for possible physical abuse Elder abuse is a possible cause of this cognitively impaired elderly client's dehydration, bruising, and weight loss. Assessment of such a possibility is advisable and takes priority over assessments of fluid intake and nutrition and implementation of fall-prevention precautions.

The nurse teaches a client methods of coping with anger. The nurse concludes that the client has learned the most effective method when the client states that the client will do what when angry? A. Go for a long jog B. Talk about the anger C. Go to the basement to scream D. Concentrate on which caused the anger

B. Talk about the anger Talking about angry feelings is better than acting them out; this response indicates that the client has learned a positive coping method. Although taking a long jog or going to the basement to scream may help, it is an isolated activity that does not permit sharing of feelings and may not always be possible. Concentrating on what made the client angry may result in an escalation of angry feelings.

A family member brings a relative to the local community hospital because the relative "has been acting strange." Which statements meet involuntary hospitalization criteria? Select all that apply. A. "I cry all the time; I'm just so sad." B. "Since I retired I've been so depressed." C. "I'd like to end it all with sleeping pills." D. "The voices say I should kill all prostitutes." E. "My boss makes me so angry - he's always picking on me."

C. "I'd like to end it all with sleeping pills." D. "The voices say I should kill all prostitutes." The statement about ending it all is a suicide threat; it is a direct expression of intent without action. Likewise, the threat to harm others must be heeded. Confiding feelings of sadness or depression does not indicate that the client plans to self-harm or harm others. The statement about the boss reflects the client's feelings of anger and the cause but does not indicate a threat to self or others.

During the termination phase of a therapeutic relationship a client misses a series of appointments without any explanation. What should the nurse do? A. Terminate the relationship immediately B. Explore personal feelings with the supervisor C. Contact the client to encourage another session D. Plan to attend the remaining designated meetings

C. Contact the client to encourage another session An additional meeting is important to address the client's problem in regard to termination or determine whether there is some other reason for the client's absence. Terminating the relationship immediately will not be therapeutic, because issues will not be resolved. The nurse may want to explore personal feelings with the supervisor; however, the focus should be on the needs of the client. The client may not attend the remaining designated meetings. The nurse must reach out to help the client with the termination process.

Before discharge of an anxious client, the nurse should teach the family that anxiety can be recognized as what? A. A totally unique feeling B. Fears specifically related to the total environment C. Consciously motivated actions, thoughts, and wishes D. A pattern of emotional and behavioral response to stress

D. A pattern of emotional and behavioral responses to stress Anxiety is a human response consisting of both physical and emotional changes that everyone experiences when faced with stressful situations. Anxiety is experienced to a greater or lesser degree by every person. The fear may be related to a specific aspect of the environment rather than the total environment. Anxiety does not operate from the conscious level.

In addition to hallucinating, a client yells and curses throughout the day. What should the nurse do? A. Ignore the client's behavior B. Isolate the client until the behavior stops C. Explain the meaning of the behavior to the client D. Seek to understand what the behavior means to the client

D. Seek to understand what the behavior means to the client All behavior has meaning; before planning intervention, the nurse must try to understand what the behavior means to the client. Ignoring behavior does little to alter it and may even cause further acting out. Isolation may increase anxiety and precipitate more acting-out behavior. The nurse cannot explain the meaning of the client's behavior; only the client can.

A client is admitted to a mental health facility because of maladaptive coping behavior. How can the nurse best help the client develop healthier coping mechanisms? A. By providing a stress-free environment B. by promoting interpersonal relationships with peers C. By allowing the client to assume responsibility for decisions D. By setting realistic limits on the client's manipulative behavior

D. by setting realistic limits on the client's manipulative behavior Setting realistic limits on the client's maladaptive behavior provides structure that promotes learning acceptable behavior. No environment is stress free. The client may not be ready for relationships with peers or responsibility for decisions at this time.

What is the most appropriate long-term goal for a client experiencing dysfunctional grieving after the death of a spouse? A. Resuming previously enjoyed activities B. Eating at least two meals a day with another person C. Decreasing negativistic thinking about other people D. Relocating to a state in which other family members reside

A. Resuming previously enjoyed activities Resuming previously enjoyed activities is realistic, specific, and measurable; it relates to the client's acceptance of a new reason for being. Eating at least two meals a day with another person may be an unrealistic goal. There are no data to indicate that the client is thinking negatively about others. Relocating to a state in which other family members reside may be an unrealistic goal, or the client may not want to do this.

What is a goal for a client who has difficulty with verbal communication precipitated by psychologic barriers? A. The client will be free of injury B. The client will demonstrate decreased acting-out behavior C. The client will identify consequences of acting-out behavior D. The client will interact with other people in the environment

D. The client will interact with other people in the environment. Interacting with other people in the environment is appropriate and measurable. Being free of injury is not related to the client's problem; the priority for this client is to facilitate interaction with others. Acting-out behavior is not inherent in the situation.

A nurse is caring for a 20-year-old client. According to Erikson's developmental psychosocial theory, what is expected by 20 years of age? A. Having the capacity for love and a commitment to work B. Being creative and productive and having concern for others C. Having a coherent sense of self and plain for self-actualization D. Accepting the worth, integrity, and uniqueness of one's past and present life

3. Having a coherent sense of self and plan for self-actualization Having a coherent sense of self is a task of adolescence. By age 20 years this goal should be achieved. Young adults, ages 18 to 35 years, should still be developing meaningful relationships and establishing themselves in careers. The stage of adulthood (generativity versus stagnation) is concerned with productivity, nurture, and support of the next generation. From age 65 years to death, an individual should experience a feeling of the worth of his or her life.

A client and the client's spouse are presented with electroconvulsive therapy (ECT) as a treatment option instead of pharmacotherapy after the client experiences adverse effects of medication therapy. The nurse meets with them to discuss the procedure. What should the nurse's first action be? A. Allowing the client and family members to voice feelings, myths, and fantasies about ECT B. Clarifying misconceptions and emphasizing the therapeutic value of the procedure for the depressed individual C. Providing them with a brochure about the treatment and scheduling another time to review and answer their questions D. Completing a detailed medical and psychiatric history and then starting family and client teaching at their level of comprehension

A. Allowing the client and family members to voice feelings, myths, and fantasies about ECT It is most important for the nurse to facilitate a discussion of feelings before teaching, because misconceptions about the presumed effects on the brain, public fears, and lack of accurate information regarding ECT precipitate anxiety. Anxiety interferes with learning. Misconceptions can be clarified only after they are expressed; citing the value of the procedure will be ineffective before fears and feelings are elicited. Although written material should be provided, this is not the first action. Depending on their readiness to learn, another meeting may be necessary to continue teaching. Although teaching should be client and family centered, a structured interview just before teaching will not set the climate for learning to occur.

Which psychotherapeutic theory uses hypnosis, dream interpretation, and free association as methods to release repressed feelings? A. Behavioral model B. Psychoanalytic model C. Psychobiologic model D. Social-interpersonal model

B. Psychoanalytic model The psychoanalytic model studies the unconscious and uses the strategies of hypnosis, dream interpretation, and free association to encourage the release of repressed feelings. The behaviorist model holds that the self and mental symptoms are learned behaviors that persist because they are consciously rewarding to the individual; this model deals with behaviors on a conscious level of awareness. The psychobiologic model views emotional and behavioral disturbances as stemming from a physical disease; abnormal behavior is directly attributed to a disease process. This model deals with behaviors on a conscious level of awareness. The social-interpersonal model affirms that crucial social processes are involved in the development and resolution of disturbed behavior; this model deals with behavior on a conscious level of awareness.

A 44-year-old single woman loses her job and has been unable to find a job for 8 months. She has exhausted her savings and is overwhelmed. She comes to the crisis intervention center because she is despondent and feels hopeless. What type of crisis does the nurse identify? A. Subjective B. Situational C. Adventitious D. Maturational

B. Situational A situational crisis involves an unanticipated loss that is apparent to others. Examples include loss of a job, death of a loved one, and a change in health status such as an amputation. A subjective (internal) crisis threatens a person's well-being but is not obvious to others. Examples of subjective crises include aging, lack of independence, and loss of faith. An adventitious crisis involves natural (e.g., hurricane, tsunami) or man-made (e.g., arson, terrorist attack) traumatic events. These crises often involve numerous losses. A maturational crisis occurs in response to stress as a person experiences a predictable change. Examples of maturational crises include adolescence, marriage, parenthood, and retirement.

A resident in a nursing home recently immigrated to the United States (Canada) from Italy. How does the nurse plan to provide emotional support? A. By offering choices consistent with the client's heritage B. By assisting the client in adjusting to American culture C. By ensuring that the client understands American beliefs D. By correcting the client's misconceptions about appropriate health practices

A. By offering choices consistent with the client's heritage Adherence to a plan of care is enhanced by the nurse's providing choices consistent with the client's cultural beliefs and practices. The nurse's cultural or personal beliefs and biases should not influence or interfere with the implementation of appropriate care. Helping the client adjust to American culture is not the priority at this time; care should be adapted to the client's needs and culture. The person's cultural practices should not be addressed unless they are detrimental to the person's health.

During group therapy, the working phase usually begins when the group displays what? A. Cohesiveness B. Confrontation C. Imitative behavior D. Corrective recapitulation

A. Cohesiveness When the group becomes united (cohesive), the clients can feel accepted, valued, and part of the group; this is the optimal time for the working phase to begin. Confrontation, imitative behavior, and corrective recapitulation all occur later in the working phase of group process, not in the beginning.

A single mother of two children who recently lost her job because her company is downsizing comes to the emergency department. The woman does not know what to do and is in crisis. The mostcritical factor for the nurse to determine during crisis intervention is the client's what? A. Developmental history B. Available situational supports C. Underlying unconscious conflict D. Willingness to restructure the personality

B. Available situational supports Personal internal strengths and supportive individuals are critical to the development of a crisis intervention plan; they must be explored with the client. Although developmental history information may be helpful, it is not essential; factors concerning the current situation are paramount. Identifying unconscious conflicts takes a long time and is inappropriate for crisis intervention. Willingness to restructure the personality is a goal of psychotherapy, not crisis intervention.

A client in a psychiatric hospital requests an unaccompanied pass, but it is denied, and the client vocalizes anger toward the staff. The nurse concludes that this anger results from feelings of what? A. Hopelessness B. Indecisiveness C. Powerlessness D. Worthlessness

C. Powerlessness Anger is a common feeling when people do not have control over decisions that affect them. There is no information to indicate that the client is feeling hopeless, indecisive, or worthless.

A nursing assistant is frequently late for work and often tells the nurse manager that although he leaves his apartment early, he is delayed by heavy traffic. What defense mechanism is being used by the nursing assistant? A. Undoing B. Repression C. Rationalization D. Overcompensation

C. Rationalization Rationalization is the use of contrived, socially acceptable, and logical explanations to justify unacceptable behavior and thus keep it out of the consciousness. Undoing is an attempt to compensate for an action or communication that is considered unacceptable—for instance, by giving a gift after a disagreement. Repression is the unconscious and involuntary forgetting of painful ideas, events, or behaviors. Reaction formation, also known as overcompensation, is defined as a conscious behavior that is the opposite of an unconscious feeling.

A nurse provides crisis intervention for a client who recently left her husband because of physical abuse. Which client behaviors indicate to the nurse that the therapy has been successful? Select all that apply. A. Cries frequently throughout the day B. Sleeps more than half the day C. Utilizes healthier coping skills D. Refuses a referral to support services E. Describes the current situation realistically

C. Utilizes healthier coping skills E. Describes the current situation realistically Healthier coping provides a repertoire of skills from which to draw in future crisis situations. Being able to be objective and review the situation realistically demonstrates progress as the client moves toward resolution of the crisis. Although crying reflects that the client is expressing her feelings, usually it indicates the presence of anxiety and nonresolution of the crisis, especially if it occurs frequently throughout the day. Sleeping excessively is a maladaptive strategy. Refusing referrals to support services may indicate denial. One of the goals of crisis intervention is to develop a stronger support system.

A female nurse has been caring for a depressed 75-year-old woman who reminds her of her grandmother. The nurse spends extra time with her every day and brings her home-baked cookies. What does the nurse's behavior reflect? A. Affiliation B. Displacement C. Compensation D. Countertransference

D. Countertransference With countertransference the professional provider of care exhibits an emotional reaction to a client based on a previous relationship or on unconscious needs or conflicts. Affiliation is turning to others for support and help when stressed or conflicted. Displacement is the discharge of pent-up feelings onto something or someone else that is less threatening than the original source of the feelings. Compensation is attempting to balance deficiencies in one area by excelling in another area.

The nurse's role in maintaining or promoting the health of the older adult should be based on which principle? A. Some physiologic changes that occur as a result of aging are reversible B. Thoughts of impending death are common and depressing to most older adults C. Older adults can better accept the dependent state that chronic illness often causes D. There is a strong correlation between successful retirement and maintaining health

d. There is a strong correlation between successful retirement and maintaining health Individuals who can reflect back on life and accept it for what it was and is, and who can adjust to and enjoy the changes retirement brings, are less likely to develop health problems, especially stress-related health problems. The physiologic changes of aging may not be reversible. Most emotionally healthy older adults are not focused on thoughts of impending death. Dependence is often threatening and not easily accepted by older adults.