Exam 1: Psychosocial Well-Being

During a therapy session, a client with anorexia tells the nurse, "I measured my thighs today. They are a quarter-inch larger than they were yesterday. I feel like a pig; I'm so fat." Which potential response by the nurse is most therapeutic?

"Has something occurred that caused you to measure your thighs?" The nurse helps the client recognize the influence of maladaptive thoughts and identify situations and events that cause concern about physical appearance and weight. In discussing these situations, the nurse and client can begin to identify anxiety-provoking events and develop strategies for managing such situations without resorting to self-damaging behaviors.

The mother of a 4-year-old returns to the hospital after being away for 3 days. She is anxious and excited to be back; however, the toddler turns his back to her and scoots away as she attempts to pick him up. Which response should the nurse prioritize in this situation?

"His distrust is normal and may have lingering effects, but you should touch and soothe him as much as possible." Three characteristic, consecutive stages of response to separation have been identified: protest, despair, and denial. In the denial stage, the child begins taking interest in his or her surroundings and appears to accept the situation. However, the damage is revealed when the caregivers do visit: the child may turn away from them, showing distrust and rejection. It may take a long time before the child accepts them again; even then remnants of the damage may linger. The child may always have a memory of being abandoned at the hospital.

Which question does the nurse include during the assessment and engagement step of cognitive behavioral therapy (CBT) to determine the client's definition of the problem?

"How would you describe your current issue?" The client's definition of the problem that brought the client into treatment is explored through a series of open-ended questions. An open-ended question is one that cannot be answered with a simple yes or no response; therefore, the open-ended question is, "How would you describe your current issue?"

The nurse is educating a client about ways to recognize early signs of anger and aggression prior to demonstrating aggressive behaviors. Which statement made by the client demonstrates the education is effective?

"I may start to become restless and irritable." Earliest signs of anger include restlessness, anxiety, irritability, pacing, muscle tension, rapid breathing, perspiration, loud voice, and anger. Escalated signs include pale or flushed face, yelling, swearing, agitation, threatening, demanding, increased muscle tension like clenched fists, threatening gestures, hostility, and loss of ability to solve the problem or think clearly. Remorse is seen after the anger crisis when attempts are made at reconciliation.

A client asks the nurse to go to lunch with the client one day next week after the client is discharged. Which statement is the most therapeutic response?

"My role here is to help you recover. Let's talk about what else you can be doing after discharge." Clients with borderline personality disorder may display negative behaviors that can interfere with therapy. The nurse will have to confront clients about their behaviors and set appropriate limits.

The nurse is discussing teenage substance use with a group of caregivers of adolescent children. Which statement made by the caregivers is most accurate regarding substance use disorders in teens?

"The most common drug used by teenagers is alcohol." Alcohol is the most common mind-altering substance used by adolescents because of its easy access. Other drugs can be used also but they are less accessible because alcohol is generally in the home. Other drugs that are used by adolescents include marijuana, cocaine, heroin, methamphetamines, and nonprescribed steroids and pain medications. The statement that "every" teenager experiments with drugs is inaccurate. Teenagers do need a release from the pressures they face but outlets for this release should include healthy activities and choices. Tobacco is an addicting drug so smoking can cause many psychological and physical harms.

The nurse is caring for an infant girl in an outpatient setting. The infant has just been diagnosed with developmental dysplasia of the hip (DDH). The mother is very upset about the diagnosis and blames herself for her daughter's condition. Which response best addresses the mother's concerns?

"This is not your fault and we will help you with her care and treatment." Because the mother is crying and experiencing the initial shock of the diagnosis, the nurse's primary concern is to support the mother and assure her that she is not to blame for the DDH. While education is important, the nurse should let the mother adjust to the diagnosis and assure her that the baby and her family will be supported now and throughout the treatment period.

Which clinical situation provides an example of transference?

A female client with a history of sexual abuse exhibits a profound mistrust of male caregivers. Transference or parataxic distortion occurs when a client exhibits the same attitudes and behaviors with a caregiver as with a significant, seemingly similar person in the client's life.

Which nursing action will best assist a 15-year-old client accomplish the developmental task according to Erikson?

Allow the client's friends to visit while the client is hospitalized The developmental task of adolescence is to develop a sense of identity, or deciding who and what kind of person one is. Friends and peers are important to facilitating the adolescent in determining one's identity. Permitting the client to make decisions assists in developing autonomy, which is a toddler task. Praising facilitates initiative, which is a preschool task. Independently performing tasks assists in developing industry, which is a school-age task.

When talking with a client, the nurse notes that the client keeps backing up. What would be the most appropriate response?

Ask the client about personal space preferences. It is most appropriate to ask the client what is preferred in regard to personal space. If the nurse needs to invade the client's personal space to do an examination or take vital signs, it is important to discuss the matter. It is not appropriate to back away without assessing preference. It may make the client feel judged if the nurse asks why he or she is backing away. Moving closer to the client just perpetuates the problem.

The nurse who cared for a client in the home environment for several months learns that the client has died. What should the nurse do to support the family at this time?

Attend the funeral. It is appropriate for the nurse who took care of a client for a prolonged period to attend the funeral. It also is appropriate for the nurse to make a follow-up personal or phone call to the client's family after the funeral or memorial service to offer both concern and care for the family's well-being. Follow-up visits are important to give support to the family. Flowers may not be desired by the family. The nurse needs to do more than just remove the client's name from the care list.

Psychosocial factors can impact the body's response to stress either positively or negatively. It has been shown that social networks play a part in the psychosocial and physical integrity of a person. How do social networks affect how a body deals with stress?

By mobilizing the resources of the person The configuration of significant others that constitutes the social network functions to mobilize the resources of the person; these friends, colleagues, and family members share the person's tasks and provide monetary support, materials and tools, and guidance in improving problem-solving capabilities. Social networks cannot protect the person from other internal stressors.

A client is given a nursing diagnosis of social isolation related to withdrawal of support systems and stigma associated with AIDS. Which outcomes would indicate that the nurse's plan of care was effective? Select all that apply.

Client demonstrates beginning participation in events and activities. Client verbalizes feelings related to the changes imposed by the disease. Client identifies appropriate sources of assistance and support. For the nursing diagnosis of social isolation, outcomes indicating effectiveness of care include demonstrating a beginning level of participation in activities and events, identifying appropriate sources for assistance and support, and verbalizing feelings related to the changes resulting from the disease. Demonstrating knowledge of safer sexual practices and practices to reduce transmission risk are more appropriate for a nursing diagnosis of deficient knowledge.

An 18-year-old pregnant client is hospitalized as she recovers from hyperemesis gravidarum. The client reveals she wanted to have an abortion (elective termination of pregnancy) but her cultural background forbids it. She is very unhappy about being pregnant and even expresses a wish for a miscarriage. Which action by the nurse is most appropriate?

Contact the health care provider to report the client's feelings. The client may be experiencing a psychological situation that needs intervention by a trained professional in the area of mental health. The hyperemesis gravidarum may worsen her feelings toward the pregnancy, so reporting her feelings to the health care provider is the best action at this time. Although the nurse will continue to monitor the client's hyperemesis gravidarum, this is not the only action needed at this time and there is a better action. Encouraging the client to be positive about her situation may obstruct therapeutic communication. Sharing the information with the client's family is not appropriate, because the scenario described does not indicate that the nurse has the client's permission to share this information with the family.

The parent of a child with cerebral palsy asks how therapeutic horseback riding might benefit his adolescent. What benefits would the nurse describe? Select all that apply.

Flexibility, balance, and muscle strength tend to improve. Self-esteem and confidence usually get a boost. Flexibility, muscle strength, and balance are fostered due to the horse movement as the teen rides. Improvement in these areas would be particularly helpful to the adolescent with cerebral palsy. Improved self-esteem and confidence are also developmentally important as the youth works to establish identity. Improved appetite and resolution of sleep problems are not attributed to therapeutic horseback riding.

Which would be an expected reaction from a 5 year old when his 3-month-old infant sibling dies from Sudden Infant Death Syndrome (SIDS)?

Guilt he may have caused the death Erikson's theory for preschoolers is initiative vs guilt. Preschoolers do not understand the concept of death, therefore, the most appropriate answer is; guilt that he may have caused the death of his sibling.

A 28-year-old client in her first trimester of pregnancy reports conflicting feelings. She expresses feeling proud and excited about her pregnancy while at the same time feeling fearful and anxious of its implications. Which action should the nurse do next?

Inform the client this is a normal response to pregnancy that many women experience. The maternal emotional response experienced by the client is ambivalence. Ambivalence, or having conflicting feelings at the same time, is universal and is considered normal when preparing for a lifestyle change and new role. Pregnant women commonly experience ambivalence during the first trimester.

Children of parents who abused alcohol and substances are able to develop self-esteem and self-efficacy by developing which characteristics?

Resilience Resilience is having healthy responses to stressful situations or risky environments. Hardiness is the ability to resist illness when under stress. Social skills are a type of coping strategy. Tolerance is the ability to deal with increasing levels of stress in an adaptive way.

A client on an inpatient psychiatric unit has features of borderline personality disorder. The client is frequently angry, has an unstable sense of self, and is highly impulsive. The client can be verbally abusive to staff, who feel manipulated by the client's behaviors. Which intervention does the nurse determine as priority?

Setting limits The nurse introduces the use of limit setting when clients engage in manipulative, acting-out, dependent, or similar inappropriate behaviors.

The nurse is caring for a 3-year-old child who has an intravenous line. When medications are delivered through the line the child experiences burning. What action by the nurse will be most helpful?

Sit with the child and use distractions such as toys during the infusion. Some medications cause discomfort and burning when they are administered intravenously. Sitting with the child and providing distraction such as with toys will help distract the child during the infusion. Topical anesthetic agents may be used prior to the initiation of the intravenous device. It is not used once the IV line has been started. Telling a 3-year-old child that the medications will make him or her better is not going to be an age-appropriate means to deal with the discomforts of the medication administration. It is not realistic that the medication can be scheduled for administration when the child is sleeping.

Which situation should concern the nurse treating a postpartum client within a few days of birth?

The client feels empty since she gave birth to the neonate. A client experiencing postpartum blues may say she feels empty now that the infant is no longer in her uterus. She may also verbalize that she feels unprotected now. The other options are considered normal and would not be cause for concern. Many first-time mothers are nervous about caring for their neonates by themselves after discharge. New mothers may want a demonstration before doing a task themselves. A client may want to get some uninterrupted sleep, so she may ask that the neonate be taken to the nursery.

A 16-year-old client is highly disruptive in class and has been in trouble at home. The parent recently found the adolescent torturing a cat. When questioned, the adolescent laughed. What condition might the client be suffering from?

conduct disorder Adolescents with conduct disorder are often unmanageable at home and disruptive in the community. They have little empathy or concern for others. They may be callous and lack appropriate feelings of guilt, although they may express remorse superficially to avoid punishment. They often blame others for their actions. Risk-taking behaviors such as drinking, smoking, using illegal substances, experimenting with sex, and participating in crime are typical. Cruelty to animals or people, destruction of property, theft, and serious violation of rules are diagnostic criteria. Asperger syndrome is on the autism spectrum, where the child is extremely high in intelligence. Bipolar symptoms consist of wide swings between depression and mania. Tourette syndrome is a condition where motor and vocal tics occur.

According to Erikson, the psychosocial task of adolescence is the development of a sense of identity. A nurse can best promote the development of a hospitalized adolescent by:

encouraging peer visitation. Peer visitation gives the adolescent an opportunity to continue along the path toward independence and identity. Knowledge of the facility regimen prepares the adolescent for upcoming procedures but doesn't affect development. To achieve a sense of identity, the adolescent must gain independence from family. Tutoring may help maintain a positive self-image relative to schoolwork but doesn't affect development.

The nurse is caring for a toddler who is scheduled for an outpatient lumbar puncture. Which action by the nurse would be appropriate?

having a child life specialist interact with the toddler before and during the procedure Having a child life specialist play with the toddler would provide the greatest support for the toddler and make the greatest contribution to atraumatic care. Privacy is specifically important to the adolescent age group, rather than the toddler age group. The nurse would educate the parents of the toddler to prepare the child immediately before the procedure. One week of preparation would be more appropriate for the adolescent. Using diagrams and explanations are beneficial to the school-aged child.

When considering where to conduct a psychosocial assessment, the nurse can effectively interview which client in the unit's conference room?

the anxious client The nurse should not choose an isolated location such as a conference room for the interview, if the client is unknown to the nurse or has a history of any threatening behavior either to themselves or to others. The anxious client by diagnosis does not present a threat and so is the one best suited for the nurse to use the conference room for the interview.

The nurse provides care for a client who is hospitalized in an acute inpatient psychiatric setting. The client experiences hallucinations. Which is the best approach to include in this client's plan of care?

the use of solution-focused therapy Solution-focused therapy is one of the brief cognitive therapies used by psychiatric nurses in acute inpatient psychiatric settings. SFBT's emphasis on strengths fits well with the values of psychiatric nurses, and the techniques used are well within their scope of practice. Solution-focused approaches have been effective with hospitalized people who were experiencing delusions, hallucinations, and/or loosening of associations. The other choices are examples of cognitive therapeutic techniques that are useful in the inpatient setting; however, they may not be best for the client who is experiencing hallucinations.

interThe nurse is caring for a 12-year-old male client who demonstrates aggressive behavior by pushing and hitting other children in the recreation room. Complete the following sentence(s) by choosing from the lists of options. Client was informed that making a fist and preparing to punch another client was unacceptable. Because a warning was ignored, the nurse used a ______________ and had the client sit in a chair in the hallway for _________ minutes. The nurse talks with the client afterward as a form of _______________ to explain why the action was needed.

time out 5 follow-up A time-out is retreat to a neutral place so that clients can regain self-control. When a client's behavior begins to escalate, such as yelling or threats, a time-out may prevent aggression or acting out. The time-out chair should be in a designated location where the client can be observed during the time-out. The duration of the time-out should be 5 minutes. Talking about the time-out is a form of follow-up so that the client will be less inclined to repeat the behavior. A client who is acting out or threatening violence will not respond to distraction. A siren is not used as a warning for unacceptable behavior. A time-out should not be longer than 5 minutes. A time-out is not a form of punishment. It is a mechanism to reduce the risk of escalating potentially volatile behavior. Although the client may be demonstrating self-control by explaining why the time-out was needed, it is not the best answer.

A 4-year-old child is brought to the clinic by his parents for evaluation of a cough. Which action by the nurse would be least appropriate in promoting atraumatic care for the child?

wrapping the child tightly in a blanket to prevent him from moving around Atraumatic care refers to the delivery of care that minimizes or eliminates the psychological and physical distress experienced by children and their families in the health care system. The key principles of atraumatic care include preventing or minimizing physical stressors, preventing or minimizing separation of the child from the family, and promoting a sense of control. Allowing the parents to stay, allowing the child to touch the stethoscope, and explaining that the stethoscope may feel cold are appropriate. Wrapping the child so that he cannot move would be stressful and traumatic.

The nurse provides care to a client brought to the emergency department with injuries from a motor vehicle collision. An intravenous line was established by paramedics. The client is now refusing bloodwork, and the nurse suspects the client may have been driving while intoxicated. How should the nurse best address the client?

"Can I help answer any questions about having your blood drawn?" An open-ended statement or question is the most therapeutic response. It encourages the widest range of client responses, makes the client an active participant in the conversation, and shows the client that the nurse is interested in the client's feelings. The nurse should not make assumptions about the client's concerns. Assumptions that the client believes the procedure will take a long time or be painful, or that the client is afraid of needles, do not open the door for the volunteering of the client's reasoning. Informing the client that it is illegal to refuse blood testing for investigation of impaired driving is unwarranted, since this is the domain of law enforcement personnel, not of the nurse.

A nurse in a residential foster home is caring for a 17-year-old client with oppositional defiant disorder. The client is using profanity and refusing to complete assigned chores. The nurse reminds the client that there are only 5 minutes in which to finish the chores. The client throws a dirty plate at the wall. How should the nurse respond?

"I am sorry you are feeling so angry tonight but you must still complete your chores." An adolescent with an oppositional defiant disorder can frequently demonstrate active defiance, has frequent anger and is noncompliant with adult requests or limits. In this situation the nurse's goal is to clearly but empathetically explain the rules and firmly adhere to them. Telling the adolescent there are only a few minutes to complete the chores does not exhibit empathy. Nor does the statement "I find your language offensive." It also does not address the rules. Letting the adolescent have a few extra minutes only reinforces the negative behavior and does not respect the rules of the facility.

A client with hypothyroidism is afraid of needles and doesn't want to have their blood drawn. What should the nurse say to help alleviate the client's concerns?

"I'll stay here with you while the technician draws your blood." The nurse should tell the client that they will stay with them as the blood is drawn. This response provides the client with the reassuring presence of the nurse and enhances the therapeutic alliance, possibly providing a greater opportunity to educate the client. Although telling the client that blood won't need to be drawn as often when thyroid levels are stable provides the client with a rationale for needing blood work, it's more appropriate for the nurse to stay with the client. Saying that the procedure will be over quickly or that the physician has ordered the blood draw ignores the client's stated fear.

The nurse is providing emotional support for the parent of a 12-year-old hospitalized child. The parent tearfully reports the child's younger sibling is acting out and always seems angry with both parents. What response by the nurse would be most beneficial?

"Is there any way you can spend the evening at home with your younger child instead of at the hospital?" The sibling is likely acting out because of both the changes to the routine at home and possible feelings of neglect while the parents are focused elsewhere. The nurse should recommend the parent consider seeking assistance from family members and friends as necessary to allow for respite or relief of in-hospital care responsibilities. Using guilt-inducing tactics with the child at home would not be beneficial and could cause additional resentment. The situation at home may improve after the child is back home but the current situation should receive attention prior to discharge. Hospitalization is difficult, but saying this does not manage the concerns reported.

The nurse is educating the parents of a 7-year-old boy scheduled for surgery to help prepare the child for hospitalization. Which statement by the parents indicates a need for further teaching?

"It is best to wait and let him bring up the surgery or any questions he has." It is important to be honest and encourage the child to ask questions rather than wait for the child to speak up. The other statements are correct.

A female client is diagnosed with Alzheimer-type dementia. She resides in a long-term care facility. The client's daughter asks the health care provider to prescribe an antipsychotic to control her mother's outbursts of anger and depression. The provider orders a psychiatric consultation for the client. The client's daughter asks, "Why doesn't the provider just order an antipsychotic?" What is the nurse's best response to this family member?

"Use of antipsychotic drugs exposes clients to adverse drug effects and does not resolve underlying problems." Clients with dementia may become agitated because of environmental or medical problems. Alleviating such causes, when possible, is safer and more effective than administering antipsychotic drugs. Inappropriate use of antipsychotic drugs exposes clients to adverse drug effects and does not resolve underlying problems.

A client has entered treatment for alcohol dependency at the client's spouse's insistence. The client's spouse has threatened to leave the marriage unless the client seeks treatment. The client admits that the client drinks every day, but that the drinking is well in control. The nurse recognizes the client's comments as denial. What is the best response by the nurse?

"What negative consequences have resulted from your drinking?" To confront denial, the nurse points to the evidence of severe dysfunction that inevitably appears in the substance abuser's life. Job losses, financial problems, possible estrangement from family and friends, and legal problems are common, and the nurse can respectfully but firmly remind the client that many of these problems are a result of alcohol or drug abuse.

The nurse is assessing a 14-year-old male client when the client's parent jokes about the changes in the client's voice and the hair under his armpits. Which response by the nurse to the client's parent is most appropriate?

"Your child can become modest and self-conscious and teasing may cause embarrassment." It is never appropriate to discuss what is happening with a client in a way that is demeaning and hurtful. A 14-year-old adolescent is experiencing many bodily changes and is very self conscious. The nurse can share experiences with the client and the family, but it should not be in a way that the adolescent is embarrassed. Parents can share their experiences with the child, but they have to be open to this discussion or it can lead to an awkward experience for the adolescent. Reminding the parent of how the child is feeling and the possible feelings that can come from their interactions will bring the parent's attention to a delicate situation and is most appropriate. Simply stating these are expected findings does not address the joking manner of the parent.

A client presents to the office and is upset after finding a small lump in her breast. The nurse tries to reassure her that the lump does not automatically indicate cancer based on the understanding that what percentage of breast lumps discovered are caused by benign breast disorders?

80% Many women believe that all lumps are cancerous; however, more than 80% of all lumps discovered are benign and need no treatment. Patience, support, and education are the essential components of nursing care.

The nurse is caring for a client who recently lost an infant to sudden infant death syndrome (SIDS). The client talks about how going back to work last week and that the couple want to become pregnant again soon to have another baby. The client reports feeling sad sometimes, but also feeling happy sometimes. What stage of grief does this client demonstrate?

Acceptance This client demonstrates acceptance of the new reality. The client shows both dealing with the grief and resuming a more normal life again, such as going back to work and planning another pregnancy. It is normal for the client to still experience times of happiness and sadness, but this shows the client has moved into the acceptance stage and is accepting the loss of the baby without trying to change it. Denial would be characterized by refusing to admit the loss of the baby was real, such as believing that the baby was not really dead. Delusion is not a stage of grief, but rather a false or irrational belief that a person holds strongly to despite proof to the contrary. Bargaining would be characterized by trying to make deals to change the outcome, such as "Take me instead and let my baby live."

The nurse is interviewing an adolescent. What should the nurse recognize as an important aspect of interviewing the adolescent?

Adolescents will share more about themselves in a private conversation. All children need the opportunity to actively participate in the health history and assessment process. Adolescents may not feel comfortable addressing health issues, answering questions or being examined in the presence of parents or caregivers. Interviewing them in private often encourages them to share information that they might not contribute in front of their caregivers. Assuring the adolescent that anything shared or discussed will be confidential allows him or her to better discuss sexual needs or use of substances. Adolescents also would rather not have a peer present because they do not want to be seen as different from their peers and there is also the issue of confidentiality.

Degree of agreement between the leader's norms and the group's norms, ability to deal with members' infractions, and conformity to group norms are characteristics of what kind of groups?

All groups A group is three or more people with related goals. The following characteristics vary among different types of groups: size, homogeneity or heterogeneity of members, stability, degree of cohesiveness among members, climate, conformity to group norms, degree of agreement with the leader's and the group's norms, ability to deal with members' infractions, and goal-directedness and task orientation of the group's work.

A client who delivered her baby 3 months ago is seen in the clinic and tells the nurse that she and her husband have yet to resume a sexual relationship. The nurse notes that no contraception is currently being used. What is the most appropriate nursing diagnosis for this client?

Altered sexual pattern related to fear of pregnancy The nurse should recognize that this exceeds the recommended postpartum abstinence period and might contribute to a fear of a repeat pregnancy.

What is the term used to identify a person's inability to experience pleasure in things that use to result in pleasure?

Anhedonia Anhedonia is the inability to experience pleasure, while alogia is the tendency to speak very little. Avolition is the lack of motivation towards goals. Affective flattening is the lack of emotional expression.

Which term describes the process by which a person experiences grief?

Bereavement Grieving, also known as bereavement, is the process by which a person experiences the grief. Homeostasis is the return to normal. Mourning is the outward expression of grief. Attentive presence is being with the client and focusing intently on communicating with and understanding him or her.

The nurse contacts a child life specialist (CLS) to work with children on a pediatric ward. What is the primary goal of the CLS?

Decrease anxiety and fear during hospitalization and painful procedure. The CLS is a specially trained individual who provides programs that prepare children for hospitalization, surgery, and other procedures that could be painful (Child Life Council, 2010a, 2010b). The goal of the CLS is to decrease the anxiety and fear while improving and encouraging understanding and cooperation of the child. The CLS may use distraction techniques and act as a liaison, but that is not the primary goal of the CLS role. The CLS does not perform medical procedures.

Which would be most important for a nurse to do when caring for a client with somatic symptom disorder?

Develop a sound, positive nurse-client relationship Although administering prescribed pharmacotherapy, counseling, and assisting in developing a daily routine are important, the most crucial part of the plan of care is developing a sound, positive nurse-client relationship. Without the relationship, the nurse is just one more provider who fails to meet the client's expectations.

What are the precipitant factors that are likely to cause a relapse of addictive, abusive behavior? Select all that apply.

Emotional stress Physical stress Environmental triggers Easy access to the substance of choice Precipitants for relapse include stress, environmental cues or triggers, and exposure to the substance. It is rare that cultural beliefs would support abusive behavior.

A nurse is developing a plan of care for a client to meet the client's self-actualization needs. The nurse would focus on which area as most important?

Emphasizing the client's strengths To help meet a client's self-actualization needs, the nurse focuses on the person's strengths and possibilities rather than on problems. Reducing fear would assist in meeting the client's safety and security needs. Promoting socialization would aid in meeting the client's love and belonging needs.

Which skill is in the psychiatric-mental health registered nurse's scope of practice?

Evaluating the effectiveness of psychiatric medications Skills and practices of the psychiatric-mental health registered nurse may include assessing and recording behavior, administering and evaluating the effectiveness of medications, communicating with other team members, and being in charge of the psychiatric milieu.

Several members of a self-help group are making T-shirts for the group to wear in a parade. This is an example of which element of group therapy?

Group cohesiveness Group cohesiveness is the development of a strong sense of group membership and alliance. Catharsis involves members relating to one another through the verbal expression of positive and negative feelings. Altruism is the process in which clients have the experience of learning to help others, and in the process, they begin to feel better about themselves. Universality can be defined as the sense of realizing that one is not completely alone in any situation.

Which is an advantage of group therapy over individual therapy for a client with a borderline personality disorder?

Group therapy provides the client with relationship opportunities upon which to test behavior modifications Group therapy differs from individual therapy in that it is more effective for treating problems with interpersonal relationships, such as for the client with a borderline personality disorder. It offers multiple relationships to assist the individual in growth and problem solving and allows psychiatric clients a greater opportunity for reality testing and experiencing mutual concern and support.

The nurse is caring for a preschool-aged child who needs a CT scan. Which action would the nurse use to best prepare the child for this diagnostic test?

Help the child to pretend that the CT scan machine is a camera. Because preschoolers' imagination is so active, this leads to several fears such as fear of the dark and mutilation. The nurse needs to help the child understand that the CT scanner is like a camera to take pictures of the body parts. Threatening the child to follow directions or becoming hurt plays into the child's fear of mutilation. Telling the child to behave creates a fear of punishment. Telling the child that the CT scan is a picture of the body's dark parts plays into the child's fear of the dark.

What kinds of thoughts does the nurse identify in a client with obsessive-compulsive disorder (OCD)? Select all that apply.

Impulsive Intrusive Unwanted The client with OCD has unwanted, intrusive, and impulsive thoughts and images. These thoughts are unreasonable and cause marked anxiety. Interesting and intelligent thoughts are not characteristic of what is described when clients experience episodes of ritualistic behavior to neutralize anxiety.

A female patient has been administered donepezil HCL for dementia. The patient has informed the nurse that she has also been taking nonsteroidal anti-inflammatory drugs. Which interaction should the nurse monitor for in this patient?

Increased risk of GI bleeding The interaction of nonsteroidal anti-inflammatory drugs with cholinesterase inhibitors causes increased risk of GI bleeding, which should be monitored for. Interaction of anticholinergics with cholinesterase inhibitors causes decreased effectiveness of anticholinergics. Interaction of theophylline with cholinesterase inhibitors causes increased risk of theophylline toxicity. Interaction of nonsteroidal anti-inflammatory drugs with cholinesterase inhibitors does not decrease the GI absorption of the drug.

An adolescent would benefit from being out of his hospital room. What can the nurse do to promote this? Select all that apply.

Invite the adolescent to meet with other teens for lunch in a common space. Challenge the adolescent to a video game in the recreation area. A video game in the "recreation area" is more appealing than investigating the "playroom." If only one activity space is available, avoid calling it the playroom to school-agers and teens. Arranging for teens to spend time together and socialize over lunch may stimulate appetites and new supportive friendships. Suggesting the adolescent leave the unit may not be safe based on his knowledge of the hospital or his condition. Doing so accompanied would be appropriate.

Which is an inaccurate depiction of self-awareness?

It involves changing one's values or beliefs. The goal of self-awareness is to know oneself so that one's values, attitudes, and beliefs are not projected to the client, interfering with nursing care. Self-awareness does not mean having to change one's values or beliefs, unless one desires to do so. Therefore, this is the inaccurate depiction of self-awareness the question asks for.

Which is accurate regarding assertive community treatment (ACT)?

It offers intensive community-based services. The ACT model is a multidisciplinary clinical team that provides nearly 24-hour, intensive community-based services. ACT typically has a low staff-to-client ratio. It helps individuals with serious mental illness live in the community.

A nurse is caring for a hospitalized 10-year-old child. What would be an appropriate activity for this child to meet the developmental tasks of this age group?

Participating in a craft project During this stage, the child is interested in how things are made and run. The child learns to manipulate concrete objects. The child likes engaging in meaningful projects and seeing them through to completion. Playing jack-in-the-box and blocks are for much younger children. If anything, the child would be texting back and forth with friends, not writing a letter.

The application of psychiatric mental health nursing theory to promote holistic client care in the therapeutic relationship is grounded in the work of which historical figure?

Peplau In 1952, Peplau published the landmark work, Interpersonal Relations in Nursing. It introduced psychiatric and mental health nursing practice to the concepts of interpersonal relations and the importance of the therapeutic relationship. The nurse-client relationship supported a holistic perspective on client care.

Some research has suggested that schizophreniform disorder may be an early manifestation of which other mental health condition?

Schizophrenia Some research has suggested that schizophreniform may be an early manifestation of schizophrenia. A client exhibiting an acute reactive psychosis for less than the 6 months necessary to meet the diagnostic criteria for schizophrenia is given the diagnosis of schizophreniform disorder. Symptoms lasting beyond the 6 months warrant a diagnosis of schizophrenia.

A 4-year-old is going to finger paint for the first time. What is the best action for the adult supervisor of this activity?

Support whatever the child paints. Preschoolers have a vivid imagination and need little direction for free-form play, such as finger painting. If a person draws a tree and tells the child to draw one, the child may no longer have fun, because the child believes that his or her tree will not look as good. The preschooler is not ready for competition and will drop out of the activity. Finger painting is a messy activity, so telling the child not to be messy takes the fun and the creative part out of the activity. The adult should provide aprons or clothing to protect the child's clothing and allow the painting in an area that can be cleaned easily.

A school-aged child with immigrant parents expresses concern to the school nurse about feeling embarrassed over the parents' limited ability to speak the dominant language, noting that classmates are sometimes cruel. After counseling the child, the nurse identifies that which evaluation reflects a positive outcome for this child?

The child sees their differences but no longer feels isolated because of the family's differences. When a child states that they no longer feel socially isolated because of the family's differences, this is an example of an expected outcome that has been resolved positively. Not directly confronting teasing friends usually does not make the child feel positive. Finding a voice and confronting classmates who make fun of their background is not the ideal way for the child to deal with this situation. Blending in with peers can be beneficial, but not if the child is trying to avert attention from the parents' culture.

The nurse is reviewing the health record of a client who developed posttraumatic stress disorder (PTSD) following a spouse's cardiac arrest and death. The health record states that the client experienced derealization during the traumatic event. What assessment finding would substantiate this statement?

The client reports being unable to remember what happened during and immediately after the event. Derealization is a sense of unreality surrounding a traumatic event or the feeling of being detached from one's mental processes. Derealization often results in an absence of memories. Avoidance, hopelessness, and obsessive behaviors are evidence of trauma, but these do not demonstrate derealization.

The nurse is counseling a 28-year-old client with avoidant personality disorder. Despite being employed, the client verbalizes having low quality of life due to anxiety and isolation. Which therapeutic goals does the nurse establish as priority?

The client will experience increased self-esteem. People with avoidant personality disorder have a pattern of social discomfort, timidity, and fear of negative evaluation. They are preoccupied with what they perceive as their own shortcomings and will form relationships with others only if they believe acceptance is guaranteed. People with this disorder often view themselves as unattractive and inferior to others and are often socially inept. The priority goal should address increasing the client's self-esteem.

Which would be the least optimal environment for therapeutic communication for a client who has difficulty maintaining boundaries?

The client's room If the client is unable to maintain boundaries by expressing inappropriate conversation or physical actions, a more formal or public setting such as an interview room, conference room, or at the end of the hall would be a more appropriate place to maintain therapeutic communication.

The nurse is observing the parents of a 4-year-old child who has been admitted to the hospital. Which of the following actions indicate that the parents understand how to best minimize anxiety during their child's hospitalization? Select all that apply.

The parents bring the child's siblings for a brief visit. The parents bring the child's favorite toy to the hospital. The parents remain at the child's side during the hospitalization. The most effective means of minimizing the child's anxiety during hospitalization is to have the parents stay. Having a familiar toy helps the child to deal with the anxiety of unfamiliar surroundings. Sibling visitation can also help to ease the child's anxiety. Explaining a procedure to a young child in great detail only maximizes fear. Parents can be effective in calming and comforting a child during painful procedures, so they should remain in the room. Rewards, not punishment, should be offered to a preschooler.

The physician has made a notation in the medical record of a 17-year-old that the teen is not demonstrating successful completion of Erikson's stages of development. What behavior would be consistent with this assessment?

The teen is uncertain and frequently unable to make decisions. According to Erikson's stages of development, the teen develops a sense of identity. Failure to successfully complete this stage will result in a lack of self confidence and an inability to see one's self as in independent being. The establishment of the ability to trust is completed in an earlier stage of psychosocial development. A desire to move away from the parental home is not uncommon and is not a sign of impaired navigation of this level of psychosocial development.

A client is diagnosed with a delusional disorder. While providing care to the client, the nurse assesses the client's delusions. Which would be least appropriate for the nurse to do?

Try to change the client's delusional belief By definition, delusions are fixed, false beliefs that cannot be changed by reasonable arguments. The nurse should assess the client's delusion to evaluate its significance to the client, to the client's safety, and to the safety of others. The nurse should not dwell on the delusion or try to change it.

The nurse is using the DSM-5-TR for a newly admitted client diagnosed with bipolar I disorder. Which information will the nurse obtain to assist with the use of this resource?

Use as a guide for client assessment The DSM-5-TR provides standard nomenclature, presents defining characteristics, and identifies underlying causes of mental disorders. It does not provide care plans or prognostic outcomes of treatment. The DSM-5-TR does not provide coding for record-keeping or billing purposes.

A nurse caring for a client who has issues with substance abuse states, "I don't know what is wrong with this person; he is here every month for the same reason!" A peer suggests that to better determine the most overall therapeutic plan of action for this client, the client needs to try to answer which question?

What happened to this client Many people who suffer from substance abuse and other mental health disorders have and possibly still are experiencing mental, emotional, physical, or sexual trauma that has contributed to their disorders. Unless the underlying problem is addressed, medical personnel cannot effectively develop a treatment plan for that person. Psychiatric disorders develop secondary to multiple factors that create changes in the brain and how it functions. Effective treatment of those with mental health disorders can only happen if it is determined who is at risk and what factors contributed to their condition.

A parent brings their 3-year-old male child to the pediatrician's office with concerns about cognitive and social development. The parent states that the child seems to get upset easy, especially with loud noises or bright lights and starts banging their head. The parent states that the child would rather be alone than play with other children, does not like to be hugged or held, and sometimes will repeat what the parents say. During the assessment, the child does not respond when spoken to, refuses to sit on the parent's lap, and avoids eye contact. Complete the following sentence(s) by choosing from the lists of options. The nurse determines the child is exhibiting signs and symptoms of _______________ and will require ________________.

autism spectrum disorder (ASD) referral to early intervention programs cognitive-behavioral therapy (CBT) The child is exhibiting neurobiologic signs and symptoms of autism spectrum disorder (ASD). Signs and symptoms of ASD include inattentiveness, lack of social interaction, difficulty with communication, repetitive behaviors and obsessive interests. A child with ASD have difficulty with communication, behavior, and social interaction and will require a multidisciplinary team to address these issues. A child diagnosed with autism spectrum disorder (ASD) should be referred to an early intervention program. Early intervention measures include the development of an individualized education plan (IEP) with the school system to align the needs of the child for maximal learning and minimal distress; consultation with a speech therapist to help improve communication; behavioral health specialists and developmental pediatrician; and pharmacotherapy such as methylphenidate. Signs and symptoms of attention deficit hyperactivity disorder (ADHD) include short attention span, impulsivity, and difficulty with movement, not social withdrawal, echolalia, or head banging. Signs and symptoms of anxiety include headaches, abdominal pain, nausea, vomiting, palpitations, and dizziness, not social isolation, head banging, or echolalia. Methylphenidate is used to treat ADHD, not ASD. Cognitive-behavioral therapy is used to treat anxiety, not ASD.

A nurse is discussing ways parents can foster the development of self-confidence in their school-aged child. Which action if stated by the parents would lead the nurse to continue the discussion?

comparing the child to an older sibling regarding academic achievements A school-age child needs consistency, clearly defined expectations, and positive attention in order to develop self-confidence. By being accepting of mistakes the child makes, focusing on the child whenever they are talking, and making sure the child understands behavioral expectations, the parents are fostering self-confidence in the child.

A school-aged child needs to have an IV started. Where would be the best place for the nurse to perform this procedure?

in a treatment room All treatments are performed in a treatment room so the child's room remains a "safe zone" for the child. By maintaining the client's room as a safe place, the child is reassured that nothing bad will happen when he or she is in the room. Procedures are never performed in public places such as a playroom to maintain the child's privacy. Distractions are provided in the treatment room.

A 16-year-old girl is being seen for a long-overdue checkup. Her caregiver has come with her. She is calm, pleasant, and in good spirits. The caregiver reports to the nurse that she is relieved because for the past 6 months the teenager has been lethargic, angry, and sad. The mother reports that since she got her driver's license two days earlier, her child's mood has changed dramatically. Rather than resist this appointment, the girl had simply smiled and said, "It won't matter much, but okay, I'll be ready in a minute." The nurse recognizes that the child's seeming well-being and drastic change in behavior should be further investigated to determine if the child:

is planning to commit suicide. Attempted suicide rarely occurs without warning and usually is preceded by a long history of emotional problems, difficulty forming relationships, feelings of rejection, and low self-esteem. Suicidal adolescents may appear suddenly elated after a long period of acting dejected, and might verbalize their hopelessness with statements such as "I won't be around much longer," or "After Monday, it won't matter anyhow." Some deaths reported as accidents, particularly one-car accidents, are thought to be suicides.

A nurse is using a doll to explain what will be done when starting an intravenous (IV) line on a 4-year-old child. What type of play is this?

therapeutic play Play is a very important part of nursing care. Therapeutic play is nondirected and focuses on helping the child cope with feelings and fears. It helps the child deal with the challenges of illness and hospitalization. Therapeutic play is a technique to help children better understand what will be happening to them in a specific situation. For instance, the child who will have an IV line started before surgery might be given the materials and encouraged to "start" an IV on a stuffed animal or doll. Emotional play or play therapy is play that allows the child to act out stressors or dramatize real-life stressors. For example, to relieve anger a child may be given something to pound. Interactive play is where children play together cooperatively. Parallel play is where toddlers play side by side but not together.