Foundations of Mental Health
A client is participating in a therapy group & focuses on viewing all team members as equally important in helping the clients meet their goals. The nurse is implementing which therapeutic approach? 1. Milieu therapy 2. Interpersonal therapy 3. Behavior modification 4. Support group therapy
1. Milieu therapy Rationale: All treatment team members are viewed as significant & valuable to the client's successful treatment outcomes in milieu therapy. Interpersonal therapy is based on a one-to-one or group therapy approach in which the therapist-client relationship is often used as a way for the client to examine other relationships in her or his life. Behavior modification is based on rewards & punishment. Support groups are based on the premise that individuals who have experienced and are insightful concerning a problem are able to help others who have a similar problem.
The nurse calls security & has physical restraints applied to a client who was admitted voluntarily when the client becomes verbally abusive, demanding to be discharged from the hospital. Which represents the possible legal ramifications for the nurse associated with these interventions? (select all that apply) 1. Libel 2. Battery 3. Assault 4. Slander 5. False Imprisonment
2. Battery 3. Assault 5. False Imprisonment Rationale: False imprisonment is an act w/ the intent to confine a person to a specific area. The nurse can be charged w/ false imprisonment if the nurse prohibits a client from leaving the hospital if the client has been admitted voluntarily and if no agency or legal policies exist for detaining the client. Assault & battery are related to the act of restraining intervention. Libel & slander are not applicable here since the nurse did not write or verbally make untrue statements about the client.
A client is preparing to attend a Gamblers Anonymous meeting for the first time. The nurse should tell the client that which is the first step in this 12-step program? 1. Admitting to having a problem 2. Substituting other activities for gambling 3. Stating that the gambling will be stopped 4. Discontinuing relationships w/ people who gamble
1. Admitting to having a problem Rationale: The first step in the 12-step program is to admit that a problem exists. Substituting other activities for gambling may be a strategy but it is not the first step. The remaining options are not realistic strategies for the initial step in a 12-step program.
The nurse employed in a mental health clinic is greeted by a neighbor in a local grocery store. The neighbor says to the nurse, "How is Carol doing? She is my best friend and is seen at your clinic every week." Which is the most appropriate nursing response? 1. "I cannot discuss any client situation w/ you." 2. "If you want to know about Carol, you need to ask her yourself." 3. "Only because you're worried about a friend, I'll tell you that she is improving." 4. "Being her friend, you know she is having a difficult time & deserves her privacy."
1. "I cannot discuss any client situation w/ you." Rationale: The nurse is required to maintain confidentiality regarding the client & the client's care. Confidentiality is basic to the therapeutic relationship& is a client's right. The most appropriate response to the neighbor is the statement of that responsibility in a direct, but polite manner. A blunt statement that does not acknowledge why the nurse cannot reveal client information may be taken as disrespectful & uncaring. The remaining options identify statements that do not maintain client confidentiality.
A client admitted voluntarily fro treatment of an anxiety problem demands to be released from the hospital. Which action should the nurse take initially? 1. Contact the client's health care provider 2. Call the client's family to arrange for transportation 3. Attempt to persuade the client to stay "for only a few more days." 4. Tell the client that leaving would likely result in an involuntary commitment
1. Contact the client's health care provider Rationale: In general, clients seek voluntary admission. Voluntary clients have the right to demand & obtain release, unless they pose an immediate danger to themselves or others, in which case the admission could become involuntary depending on the circumstances & regulations in that area & facility. The nurse needs to be familiar w/ the state & facility policies & procedures. The initial nursing action is to contact the PHCP, who has the authority to discuss discharge with the client. while arranging the safe transportation is appropriate, it is premature in this situation and should be done only w/ the client's permission. While it is appropriate to discuss why the client feels the need to leave & the possible outcomes of leaving against medical advice, attempting to get the client to agree to staying "For only a few more days" has little value & will not likely be successful. Many states require that the client submit a written release notice to the facility psychiatrist, who reevaluates the client's condition for possible conversion to involuntary status if necessary, according to criteria established by law. While this is a possibility, it should not be used as a threat with the client.
When reviewing the admission assessment, the nurse notes that a client was admitted to the mental health unit involuntarily. Based on this type of admission, the nurse should provide which intervention for this client? 1. Monitor closely for harm to self or others 2. Assist in completing an application for admission 3. Supply the client w/ written information about her or his mental health problem 4. Provide an opportunity for the family to discuss why the felt the admission was needed
1. Monitor closely for harm to self or others Rationale: Involuntary admission is necessary when a person is a danger to self or others or is in need of psychiatric treatment regardless of the client's willingness to consent to the hospitalization. A written request is a component of a voluntary admission. Providing written information regarding the mental health problem, is likely premature initially. The family may have had no role to play in the client's admission.
The nurse in the mental health unit plans to use which therapeutic communication techniques when communicating w/ a client? (select all that apply) 1. Restating 2. Active listening 3. Asking the client "Why?" 4. Maintaining neutral responses 5. Providing acknowledgement & feedback 6. Giving advice & approval or disapproval
1. Restating 2. Active listening 4. Maintaining neutral responses 5. Providing acknowledgement & feedback Rationale: Therapeutic communication techniques include listening, maintaining silence, maintaining neutral responses, using broad openings & open-ended questions, focusing & refocusing, restating, clarifying & validating sharing perceptions, reflecting, providing acknowledgement & feedback, giving information, presenting reality, encouraging formulation of a plan of action, providing nonverbal encouragement, & summarizing. Asking "why" is often interpreted as being accusatory by the client & should also be avoided. Providing advice or giving approval or disapproval are barriers to communication
The nurse should plan which goals of the termination stage of group development? (select all that apply) 1. The group evaluates the experience 2. The real work of the group is accomplished 3. Group interaction involves superficial conversation 4. Group members become acquainted w/ one another 5. Some structuring of group norms, roles, & responsibilities take place 6. The group explores members' feelings about the group & the impeding separation
1. The group evaluates the experience 6. The group explores members' feelings about the group & the impeding separation Rationale: The stages of group development include the initial stage, the working stage ,and the termination stage. During the initial stage, the group members become acquainted w/ one another, & some structuring of group norms, roles, & responsibilities take place. During the initial stage, group interaction involves superficial conversation. During the working stage, the real work of the group is accomplished. During the termination stage, the group evaluates the experience & explores members' feelings about the group & the impeding separation.
A client experiencing disturbed thought processes believes that his food is being poisoned. Which communication technique should the nurse use to encourage the client to eat? 1. Using open-ended questions & silence 2. Sharing personal preference regarding food choices 3. Documenting reasons why the client does not want to eat 4. Offering opinions about the necessity of adequate nutrition
1. Using open-ended questions & silence Rationale: Open-ended questions & silence are strategies used to encourage clients to discuss their problems. Sharing personal food preferences is not a client-centered intervention. The remaining options are not helpful to the client because they do not encourage the client to express feelings. The nurse should not offer opinions & should encourage the client to identify the reasons for the behavior.
A client diagnosed w/ terminal cancer says to the nurse "I'm going to die, and I wish my family would stop hoping for a cure! I get so angry when they carry on like this. After all, I'm the one who's dying." Which response by the nurse is therapeutic? 1. "Have you shared your feelings w/ your family?" 2. "I think we should talk more about your anger w/ your family." 3. "You're feeling angry that your family continues to hope for you to be cured?" 4. "You are probably very depressed, which is understandable w/ such a diagnosis."
3. "You're feeling angry that your family continues to hope for you to be cured?" Rationale: Restating is a therapeutic communication technique in which the nurse repeats what the client says to show understanding and to review what was said. Although it is appropriate for the nurse to attempt to assess the client's ability to discuss feelings openly w/ family members, it does not help the client discuss the feelings causing the anger. The nurse's direct attempt to expect the client to talk more about the anger is premature. The nurse would never make a judgement regarding the reason for the client's feeling; this is non-therapeutic in the one-to-one relationship
The nurse visits a client at home. The client states "I haven't slept at all the last couple of nights." Which response by the nurse demonstrates therapeutic communication? 1. "I see." 2. "Really?" 3. "You're having difficulty sleeping?" 4. "Sometimes I have trouble sleeping too."
3. "You're having difficulty sleeping?" Rationale: The correct option uses the therapeutic communication technique of restatement. Although restatement is a technique that has a prompting component to it, it repeats the client's major theme, which assists the nurse to obtain a more specific perception of the problem from the client. The remaining options are not therapeutic responses because none of them encourage the client to expand on the problem. Offering personal experiences moves the focus away from the client & onto the nurse.
A client w/ a diagnosis of depression who has attempted suicide says to the nurse. "I should have died. I've always been a failure. Nothing ever goes right for me." Which response by the nurse demonstrates therapeutic communication? 1. "You have everything to live for." 2. "Why do you see yourself as a failure?" 3. "Feeling like this is all part of being depressed." 4. "You've been feeling like a failure for a while?"
4. "You've been feeling like a failure for a while?" Rationale: Responding to the feelings expressed by a client is an effective therapeutic communication technique. The correct option is an example of the use of restating. The remaining options block communication because they minimize the client's experience and do not facilitate exploration of the client's expressed feelings. In addition, use of the word why is non-therapeutic because clients frequently interpret why questions as accusations. Why questions can cause resentment, insecurity & mistrust.
On review of the client's record, the nurse notes that the admission was voluntary. Based on this information, the nurse plans care anticipating which client behavior? 1. Fearfulness regarding treatment measures 2. Anger & aggressiveness directed toward others 3. An understanding of the pathology & symptoms of the diagnosis 4. A willingness to participate in the planning of the care & treatment plan.
4. A willingness to participate in the planning of the care & treatment plan. Rationale: In general, clients seek voluntary admission. If a client seeks voluntary admission, the most likely expectation is that the client will participate in the treatment program since she or he is actively seeking help. The remaining options are not characteristics of this type of admission. Fearfulness, anger, & aggressiveness are more characteristic of an involuntary admission. Voluntary admission does not guarantee that a client understands her or his mental health problem, only the client's desire for help
When a client is admitted to an inpatient mental health unit w/ the diagnosis anorexia nervosa, a cognitive behavioral approach is used as part of the treatment plan. The nurse plans care based on which purpose of this approach? 1. Providing a supportive environment 2. Examining intrapsychic conflicts & past issues 3. Emphasizing social interaction w/ clients who withdraw 4. Helping the client to examine dysfunctional thoughts & beliefs
4. Helping the client to examine dysfunctional thoughts & beliefs Rationale: Cognitive behavioral therapy is used to help the client identify & examine dysfunctional thoughts & to identify & examine values & beliefs that maintain these thoughts. The remaining options, while therapeutic in certain situations, are not the focus of cognitive behavioral therapy.
The nurse is working with a client who despite making a heroic effort, was unable to rescue a neighbor trapped in a house fire. Which client-focused action should the nurse engage in during the working phase of the nurse-client relationship? 1. Exploring the client's ability to function 2. Exploring the client's potential for self-harm 3. Inquiring about the client's perception or appraisal of why the rescue was unsuccessful 4. Inquiring about & examining the client's feelings for any that may block adaptive coping
4. Inquiring about & examining the client's feelings for any that may block adaptive coping Rationale: The client must first deal w/ feelings & negative responses before the client can work through the meaning of the crisis. The correct option pertains directly to the client's feelings & is client-focused. The remaining options do not directly focus on or address the client's feelings.
What is the most appropriate nursing action to help manage a manic client who is monopolizing a group therapy session? 1. Ask the client to leave the group for this session only 2. Refer the client to another group that includes other manic clients 3. Tell the client to stop monopolizing in a firm but compassionate manner 4. Thank the client for the input, but inform the client that others now need a chance to contribute
4. Thank the client for the input, but inform the client that others now need a chance to contribute Rationale: If a client is monopolizing the group the nurse must be direct & decisive. The best action is to thank the client & suggest that the client stop talking & try listening to others. Although telling the client to stop monopolizing in a firm but compassionate manner may be a direct response, the correct option is more specific & provides direction for the client. The remaining options are inappropriate because they are not directed toward helping the client in a therapeutic manner.
