Module 1 Test MH

A nurse is preparing a presentation for a local community group about mental disorders and plans to include how mental disorders are different from medical disorders. Which statement would be most appropriate for the nurse to include? A) "Mental disorders are defined by an underlying biological pathology." B) "Numerous laboratory tests are used to aid in the diagnosis of mental disorders." C) "Clusters of behaviors, thoughts, and feelings characterize mental disorders." D) "Manifestations of mental disorders are within normal, expected parameters."

C) "Clusters of behaviors, thoughts, and feelings characterize mental disorders." Feedback: Unlike many medical disorders, mental disorders are defined by clusters of behaviors, thoughts, and feelings, not underlying biological pathology. The alterations in thoughts, behaviors, and feelings are unexpected and outside normal, culturally defined limits. Laboratory tests are not used in diagnosing mental disorders.

The charge nurse is talking with another nurse who states, "I feel like my clients have no interest in their care and do not care that I am trying to help." Which response should the charge nurse make? A) "A lot of clients behave that way, but you cannot take it personally." B) "Do you want me to assign another nurse?" C) "Have you tried to establish a therapeutic relationship with the clients?" D) "Clients often behave that way when they are in pain."

C) "Have you tried to establish a therapeutic relationship with the clients?" Feedback: The charge nurse should ask if the nurse has tried to establish therapeutic relationships with the clients. Establishing this relationship helps with a feeling of connectedness for the client and promotes behavior changes needed to improve health and well-being. The other options dismiss the nurse's concerns or make assumptions about the client.

A nurse working on a psychiatric unit receives a telephone call from a client's employer. The employer asks for a copy of the client's latest laboratory work and psychological testing results so that the client's medical records in employee health can be updated. Based on the nurse's knowledge of breach of confidentiality, which response would be the appropriate? A) "I'm sorry; we're not allowed to give out that information about our client." B) "I'll have to get the client's signed consent before we can send that information to you." C) "I am unable to acknowledge whether or not your employee is a client on this unit." D) "Sure, give me your address, and I will see that the information is sent to you."

C) "I am unable to acknowledge whether or not your employee is a client on this unit." Feedback: A breach of confidentiality is the release of client information without the client's consent in the absence of legal compulsion or authorization to release information. Acknowledging that this employee is a client on the unit would be such a breach. Even if the nurse explains that he or she cannot give the information without the client's consent, the explanation lets the employer know that the client is receiving care in a psychiatric hospital.

A psychiatric-mental health nurse is working with a client who is being treated for depression. Which statement by the client would indicate that the client's spirituality is intact? A) "My church friends came to visit me this past Sunday afternoon." B) "Nothing will ever be the same again; my life is not worth living." C) "I know I am as well off as I can be under the circumstances." D) "I know God must be punishing me for all my sins."

C) "I know I am as well off as I can be under the circumstances." Feedback: Perception of well-being and health in persons with severe mental illness has been positively associated with spirituality; this answer implies that the client has a sense of well-being despite depression. The statement about church friends visiting reflects the client's religiousness or participation in a community of people who gather around common ways of worshiping. The statements about life not being worth living and that God is punishing the client for the client's sins reflect hopelessness.

A psychiatric-mental health nurse is conducting a seminar for a group of colleagues about the impact of spirituality and religion on mental illness. The nurse determines that the teaching was successful based on which group statement? A) "If a person is spiritual, then that person is also religious." B) "Being religious requires a person to use self-reflection" C) "Religion and spirituality can be helpful in dealing with mental illness." D) "Spirituality involves gathering for group worship."

C) "Religion and spirituality can be helpful in dealing with mental illness." Feedback: Religion and spirituality can provide support and strength in dealing with mental illnesses and emotional problems. Spirituality develops over time and is a dynamic, conscious process characterized the personal development of meaning, belief, connection, self-transcendence, and value. Related but different than spirituality, religiousness is the participation in a community of people who gather around common ways of worshiping. Although spirituality can be expressed through adhering to a particular religion, it can also be expressed in the absence of religion. Religiousness does not necessarily require self-reflection.

A nursing instructor is integrating Piaget's theory of cognitive development into the discussion of learning and mental health issues affecting adolescents. The instructor would identify this age group as in what stage? A) Concrete operations B) Preoperational C) Formal operations D) Sensorimotor

Feedback: Adolescents are in the formal operations stage of development. School-age children are in the concrete operations stage. Children between the ages of 2 and 7 years are in the preoperational stage of cognitive development. Infants and toddlers to age 2 years are in the sensorimotor stage.

A psychiatric-mental health nurse is providing care to a client at a community mental health center. When documenting the client's care, which statements would be most appropriate to include? Select all that apply. A) "Client refused to participate in group therapy session today." B) "Client is manipulating staff members for special treatment." C) "Client has no issues." D) "Client answers questions clearly and completely." E) "Client states, 'The relaxation exercises are helping with anger.'"

A) "Client refused to participate in group therapy session today." D) "Client answers questions clearly and completely." E) "Client states, 'The relaxation exercises are helping with anger.'" Feedback: When documenting care, all entries should be clear, well written, and void of jargon. Judgmental statements, such as "client is manipulating staff" should not be included in records. Only meaningful, accurate, objective descriptions of behavior should be used. General, stereotypical statements, such as "had a good night" or "no issues" are meaningless and should be avoided. Statements depicting the client's behavior, such as refusing to participate in group therapy and answering questions clearly and completely, as well as direct patient statements are valid entries.

A nursing instructor is explaining to a group of nursing students that a forensic client experiences stigma associated with being mentally ill and with being a criminal. One of the students asks the instructor how the stigma associated with criminality might influence nursing care. Which response by the instructor is appropriate? A) "Nurses may be reluctant to care for mentally ill criminals because of unrealistic fears for their own safety and that of their other clients." B) "Nurses may prefer to care for forensic clients because they do not believe criminals can be mentally ill." C) "A nurse may volunteer to work only with forensic clients because of the belief that forensic clients experience only mild mental health problems." D) "Nurses are generally only reluctant to care for mentally ill criminals if the crime committed was more serious, such as murder."

A) "Nurses may be reluctant to care for mentally ill criminals because of unrealistic fears for their own safety and that of their other clients." Feedback: Forensic clients experience the combined effects of the stigma of mental illness and criminality. Although the stigma is an issue for all persons with mental illnesses, it is magnified for those who have committed a crime. There is often reluctance on the part of mental health professionals to treat these clients, especially if murder and child sexual abuse are involved. Even if the worry is unfounded, clinicians express safety concerns for themselves and other clients and may refuse to care for these clients.

The nurse understands the need to use appropriate language to help address public stigma surrounding mental health issues. Which statement best reflects this understanding? A) "The client diagnosed with schizophrenia needs additional assistance." B) "The bipolar in room 222 is really out of control today." C) "That client down the hall is a raving maniac." D) "That hyperactive client is acting like a psycho."

A) "The client diagnosed with schizophrenia needs additional assistance." Feedback: One way to reduce public stigma is to use non-stigmatizing language. Rather than referring to the client as schizophrenic or bipolar, it is more appropriate to say "the client diagnosed with schizophrenia" or "the client diagnosed with bipolar disorder." Terms such as maniac and psycho reinforce the negative images of mental illness.

The nurse is caring for a client with a diagnosis of severe depression and the client's sibling states, "Can you just stop being so dramatic and snap out of this." Which response by the nurse would be most appropriate? A) "Would you be willing to understand how depression works in the brain?" B) "You should probably leave the room for awhile." C) "People cannot just snap in and out of feeling sad." D) "Do you understand that depression is a disease?"

A) "Would you be willing to understand how depression works in the brain?" Feedback: The most appropriate response would be asking if the sibling is willing to be educated about depression. Telling the sibling to leave may not be what the client wants. Telling the sibling the client cannot snap in and out or that depression is a disease does not really give the sibling an understanding of why the client feels sad. Educating people is a way the nurse can advocate for the client and would be the best response.

The nurse is talking with a client recovering from a substance abuse disorder for more than 1 year at a follow-up visit. The client asks, "How do I become a peer support specialist, so I can help others recover?" Which response(s) should the nurse make? Select all that apply. A) "You must become certified in specific competencies." B) "Peer support specialists must have recovered from at least one relapse." C) "Peer support specialists are volunteers." D) "You will need to be comfortable with managing crisis." E) "You must be willing to share your own stories and experiences with others."

A) "You must become certified in specific competencies." C) "Peer support specialists are volunteers." D) "You will need to be comfortable with managing crisis." E) "You must be willing to share your own stories and experiences with others." Feedback: All of the options except experiencing at least one relapse are related to competencies for peer workers in behavior health services and the role of the peer support person.

The nurse is developing a person-centered care plan for a client diagnosed with suicidal ideations. Which action should the nurse take? A) Ask if the client would feel safer having inpatient care or making a 24-hour safe contract. B) Ask if the client understands what the Baker Act is. C) Teach the client about the benefits of a newly prescribed antidepressant medication. D) Teach the client about the need for one-to-one care.

A) Ask if the client would feel safer having inpatient care or making a 24-hour safe contract. Person-centered care actively involves the client in the client's own care. This allows the client to be educated about treatment options and the disorder, so the client can make educated decisions about the care. The nurse should ask the client about safety and if the client would rather check into inpatient care in order to stay safe or if the client wants to make a contract to promise not to hurt oneself for the next 24-hours. The other options do not allow the client to participate in decision- making, but rather tell the client about treatment the client will receive without the client's input.

The nurse is explaining the concept of the shared decision-making model to the spouse of a client who was involuntarily admitted for a substance use disorder. The spouse states, "Is it really a good idea to let my spouse help make decisions since this is involuntary, and the decisions my spouse made to begin with is why we are here?" Which response would be most appropriate by the nurse? A) "Your spouse still has rights, and this model can help improve the success of recovery." B) "You can make decisions for your spouse, if you become the conservator." C) "Do you think your spouse will try to make bad choices for treatment options, because your spouse has an addiction problem?" D) "The health care provider has the final say in the treatment, so your spouse will get the care needed."

A) "Your spouse still has rights, and this model can help improve the success of recovery." Feedback: The best response by the nurse is to advocate for the client, explaining that the client has rights even if the client was admitted involuntarily. Also, explaining that the model can improve the client's success with recovery helps the spouse understand that this would be the best plan. The other options do not advocate for the client and/or are incorrect. The health care provider does not have the "final say," but rather decisions are made together to facilitate the best plan of care for the client.

The nurse is planning care for a group of clients using the recovery model. Which clients should the nurse include in this model? Select all that apply. A) A client with a history of personality disorder B) A client recovering from an opioid overdose C) A client diagnosed with Alzheimer's disease D) A client with an eating disorder E) A client with erectile disfunction

A) A client with a history of personality disorder B) A client recovering from an opioid overdose D) A client with an eating disorder Feedback: The recovery model was initially applied to clients with substance use disorders and then expanded to include clients with mental health disorders as well. Therefore, the nurse should include the clients who have mental health disorders including opioid overdose, personality disorder, and an eating disorder. Alzheimer's disease and erectile disfunction would not be an appropriate diagnosis for the recovery model.

The nurse is discussing empowerment with a group of people at a community health fair. Which idea(s) should the nurse include in the discussion? Select all that apply. A) A needle exchange program for individuals with substance use disorder B) Building a basketball court near the park C) Developing a support group at a church for clients with addiction D) Lobbying for building a movie theater in town E) Providing a free education program for families of clients with mental health disorders

A) A needle exchange program for individuals with substance use disorder B) Building a basketball court near the park C) Developing a support group at a church for clients with addiction E) Providing a free education program for families of clients with mental health disorders Feedback: The nurse should include all of the ideas except lobbying for a movie theater. Empowerment is related to supporting communities to take control of their own health needs, not social needs, like a theater. A needle exchange program allows for self-management. A basketball court encourages healthy behaviors. A support group can contribute to well-being, and free education for families can help promote positive mental health and decrease stigma.

A psychiatric-mental health nurse is providing care to a client diagnosed with dementia. The client has been deemed competent. The nurse understands that the client would demonstrate which behaviors? Select all that apply. A) Able to repeat what was heard B) Able to say in own words what is understood about the treatment C) Can discuss the condition but not why treatment is needed D) Can explain the logical reason for the choice of treatment E) Can express the outcome but not the reason for the treatment

A) Able to repeat what was heard B) Able to say in own words what is understood about the treatment D) Can explain the logical reason for the choice of treatment Feedback: A client who is competent should be able to: communicate choices (repeat what he or she heard); understand relevant information (able to paraphrase understanding of the treatment); appreciate the situation and its consequences (discuss the disorder, need for treatment, likely outcomes, and reason treatment is being suggested); and use a logical thought process to compare the risks and benefits of treatment options (discuss the logical reasons for the treatment choice).

A nurse is developing a plan of care integrating Maslow's hierarchy of needs. Which area would the nurse identify as the priority? A) Adequate food B) Predictable social environment C) Acceptance from family D) Positive self-image

A) Adequate food Feedback: According to Maslow's hierarchy, physiologic and survival needs, such as adequate food, are the priorities. These are followed by safety and security needs (predictable social environment), love and belonging needs (acceptance from family), and esteem needs (positive self-image).

A psychiatric-mental health nurse is working on an inpatient unit that uses a privilege system. The nurse understands that this intervention integrates which group of theories? A) Behavioral B) Developmental C) Humanistic D) Cognitive

A) Behavioral Feedback: Interventions such as privilege systems and token economies are interventions based on behavioral theories. Understanding childhood and adolescent experiences and their manifestations as adult problems reflects developmental theories. Exploring personal capabilities to develop self-worth reflects humanistic theories. Focusing on thought processes and how they relate to behavior reflects cognitive theories.

A group of nursing students is reviewing information about psychodynamic theories. The students demonstrate a need for additional study when they identify who as a humanistic theorist? A) Carl Jung B) Carl Rogers C) Abraham Maslow D) Frederick Perls

A) Carl Jung Feedback: Carl Jung is considered a Neo-Freudian theorist. Rogers, Maslow, and Perls are considered humanistic theorists.

During assessment, the nurse learns that the client follows Buddhist beliefs. The nurse would integrate understanding of which when developing the client's plan of care? A) Desire is the cause of all human suffering and misery. B) Self-indulgence is necessary to reach nirvana. C) Present behavior is based on current unhappiness. D) Vision is achieved through role playing.

A) Desire is the cause of all human suffering and misery. Feedback: Buddhism attempts to deal with problems of human existence, such as suffering and death, with the belief that all human suffering and misery are caused by desire. Self-indulgence is to be avoided; good deeds and compassion facilitate the process toward nirvana. Salvation through faith and humility reflects the beliefs of Christianity.

As part of a class activity, nursing students are engaged in a small-group discussion about the epidemiology of mental illness. Which statement best explains the importance of epidemiology in understanding the impact of mental disorders? A) Epidemiology helps promote understanding of the patterns of occurrence associated with mental disorders. B) Epidemiology helps explain research findings about the neurophysiology that causes mental disorders. C) Epidemiology provides a thorough theoretical explanation of why specific mental disorders occur. D) Epidemiology predicts when a specific psychiatric client will recover from a specific mental disorder.

A) Epidemiology helps promote understanding of the patterns of occurrence associated with mental disorders. Feedback: Epidemiology is the study of patterns of disease distribution and determinants of health within populations. It contributes to the overall understanding of the mental health status of population groups, or aggregates, and it examines the associations among possible factors. Epidemiology does not explain research findings about neurophysiology, provide theoretical explanations for why specific disorders occur, or predict recovery.

A nursing student is to provide a class presentation about interpersonal and psychoanalytic theories. As part of this presentation, the student is planning to address the major way these two categories differ. Which would the student include as key to interpersonal theories? A) Human relationships B) Instincts C) Drives D) Potential for goodness

A) Human relationships Feedback: Although there are similarities between psychoanalytic and interpersonal theories, the major difference is that interpersonal theories acknowledge the importance of individual relationships in personality development. Instincts and drives are less important. The potential for goodness forms the basis of humanistic theories.

When describing the influence of Harry Stack Sullivan on psychiatric-mental health nursing, which would an instructor address as a major concept? A) Interpersonal relations B) Harmony between the individual and society C) Collective unconscious D) Unconditional positive regard

A) Interpersonal relations Feedback: Harry Stack Sullivan (1892-1949), an American psychiatrist, extended the concept of interpersonal relations to include characteristic interaction patterns. Rogers addressed the concept of unconditional positive regard. Fromm addressed the need for harmony and understanding between an individual and society. Jung addressed the collective unconscious such that individuals had both extroverted and introverted tendencies.

A client receives a court order for commitment. Which concept exemplifies a "least restrictive environment?" A) Involuntary commitment to an outpatient community mental health center B) Medication administration for sedation so the client cannot get out of bed C) Placement of client in a secured padded room in response to threats of self-harm D) Admission of client to a locked inpatient psychiatric unit

A) Involuntary commitment to an outpatient community mental health center Feedback: An example of the concept "least restrictive environment" is the involuntary commitment of a client to an outpatient mental health center. Medications cannot be given unnecessarily to keep a client in bed. An individual cannot be restrained or locked in a room unless all other "less restrictive" interventions are attempted first. Placing a client in a locked inpatient unit would also not be considered "least restrictive."

A group of nursing students is reviewing information about the various nursing theorists and their application to psychiatric-mental health nursing. The students demonstrate understanding when they identify which theorist as responsible for developing the theory of cultural care diversity and universality? A) Madeleine Leininger B) Sister Calista Roy C) Hildegard Peplau D) Dorothea Orem

A) Madeleine Leininger Feedback: The nurse-anthropologist who developed the theory of cultural care diversity and universality is Madeleine Leininger. Calista Roy developed an adaptation model. Hildegard Peplau focused on the nurse-client relationship and emphasized the power of empathy. Dorothea Orem developed the self-care deficit nursing theory.

After teaching a group of nurses about confidentiality and privacy, the group leader determines that the teaching was successful when the group identifies which aspect as privacy? A) Part of personal life not governed by society's laws B) Ethical duty for nondisclosure C) Involvement of two individuals D) Knowledge of treatment costs and benefits

A) Part of personal life not governed by society's laws Feedback: Privacy refers to that part of an individual's personal life that is not governed by society's laws and government intrusion. Confidentiality refers to an ethical duty of nondisclosure. Confidentiality also involves two people: the individual who discloses the information and the person with whom the information is shared. Informed consent is a legal procedure to ensure that the client knows the benefits and costs of treatment.

A nursing instructor is preparing a class discussion on the topic of self determinism. Which topics would the instructor expect to include? Select all that apply. A) Personal autonomy as a key value B) Choices based on pleasing others C) Activities reflecting personal goals D) Right to refuse treatment E) Empowerment

A) Personal autonomy as a key value C) Activities reflecting personal goals D) Right to refuse treatment E) Empowerment Feedback: Self-determinism is defined as being empowered or having the free will to make moral judgments. Personal autonomy and avoidance of dependence are key values. A self-determined individual is internally motivated to make choices based on personal goals, not to please others or be rewarded. It is the right to choose one's own health-related behaviors and refuse treatment.

A psychiatrist recommends that a client should participate in a 3-month outpatient aftercare program after being discharged. What would protect the client's right to request a second opinion before agreeing to this suggestion? A) Self-determinism B) Least restrictive environment C) Confidentiality D) Mandates to inform

A) Self-determinism Feedback: The right of self-determinism entitles all clients to refuse treatment, to obtain other opinions, and to choose other forms of treatment. It is one of the basic clients' rights established by Title II, Public Law 99-139, outlining the Universal Bill of Rights for Mental Health Patients. "Least restrictive environment" means that an individual cannot be restricted to an institution when he or she can be successfully treated in the community. Confidentiality is an ethical duty of nondisclosure. Mandates to inform is a term referring to the legal obligation to breach confidentiality when there is a judgment that the client has harmed, or is about to injure, another person.

A nurse is explaining advance care directives, or "living wills," to a client and the client's spouse. Which detail would the nurse include in the description of an advance care directive? A) The document tells what treatment is to be omitted if the client is unable to make the decision. B) A client is required to sign the "living will" document with an attorney is present. C) The client's physician must act as a witness when the client signs the document. D) An attorney draws up the papers to be given to the client and his or her family.

A) The document tells what treatment is to be omitted if the client is unable to make the decision. Feedback: Advance care directives, or "living wills," state what treatment should be omitted or refused if the client is unable to make those decisions. An advance care directive requires any two witnesses and notarization but does not require an attorney.

A nurse applying King's model to a nurse-client interaction identifies the outcome using what term? A) Transaction B) Adaptation C) Transpersonal caring D) Self-system

A) Transaction Feedback: According to King's theory, the outcome of the interaction within a nurse-client relationship is a transaction, defined as the transfer of value between two or more people. Adaptation is associated with Roy's model. Transpersonal caring is associated with Watson. Self-system is associated with Peplau.

The nurse is caring for a client with a history of several re-admissions for nonadherence to medications. Which action by the nurse would best help the client with medication adherence? A) Using a person-centered approach B) Gaining the client's trust before informing the client about the plan of care C) Asking why the client failed to adhere to the medication regimen D) Including a support person from home in the client's plan of care

A) Using a person-centered approach Feedback: The nurse should try a person-centered approach to help the client achieve medication adherence after discharge. Including a support person could be helpful, if the client prefers that, and it would be part of person-centered approach to ask the client about the preferences. It may be a good idea to assess what the reasons were for failed medication adherence in the past, but asking the client why may cause the client to feel defensive and would not be the best action. Gaining trust and establishing a therapeutic nurse-client relationship is also important and part of the person-centered approach. However, the nurse should not then go ahead and create a plan of care without the client's input.

A psychiatric-mental health nurse is conducting an in-service program about health literacy among clients. The nurse determines that additional teaching is needed when the group identifies which action as addressing health literacy needs? A) Using only medical terminology to ensure accuracy and consistency of communication B) Verifying that clients understand information that is communicated to them C) Assuming that all clients may have difficulty understanding health information D) Ensuring clarity of communication in both spoken and written forms

A) Using only medical terminology to ensure accuracy and consistency of communication Feedback: Health literacy is an individual's ability to process and understand health information to make care decisions. It can vary among clients based on reading, verbal, and numerical skills. To ensure that clients receive and understand all important information, nurses should assume that all clients and caregivers may have difficulty understanding health information. Nurses should communicate in ways that anyone can understand; using only medical terminology is likely to confuse clients and caregivers, leaving them poorly informed and inadequately equipped to make decisions. Clarity and ease of understanding are required in both spoken and written communication, and nurses should verify that clients and caregivers understand the information they are given.

The nurse is planning short-term goals to improve the client's self-esteem and treatment adherence. Which action by the nurse would assist the client in achieving these goals? A) Using shared decision-making model to plan the client's care B) Using the informed choice model to plan the client's care C) Referring the client for peer support after discharge D) Assisting the client in finding employment after discharge

A) Using shared decision-making model to plan the client's care Feedback: The nurse should use the shared decision-making model when planning care with the client because the benefits of this model include improving self-esteem and treatment compliance. The informed choice model allows the client to make decisions based on information presented, but this model does not contribute to improved self-esteem and treatment compliance. Referring the client and assisting the client with peer support and employment after discharge will not contribute to increased self-esteem and treatment compliance while the client is hospitalized.

A nurse is assessing a client who has come to the health care facility for treatment. During the assessment, the client states, "I don't know if there is a God or Heaven." The nurse interprets this statement to be a reflection of what belief? A) agnosticism B) atheism C) Maoism D) scientism

A) agnosticism Feedback: Agnosticism refers to the belief that whether there is a God and a spiritual world or any ultimate reality is unknown and probably unknowable. Atheism is the belief that no God exists as "God" is defined in any current existing culture of society. Maoism reflects a faith that is centered in the leadership of the Communist Party and all the people; the major belief goal is to move away from individual personal desires and ambitions toward viewing and serving all people as a whole. Scientism is the belief that values and guidance for living come from scientific knowledge, principles, and practices, and that systematic study and analysis of life, rather than superstition, lead to true understanding and practice of life.

A psychiatric-mental health nurse is interviewing a client who emigrated from an Asian country to the United States as a child. What client statement would the nurse recognize as illustrating a challenge specific to some traditional Asian cultures regarding mental health care? A) "I'm worried about how much treatment is going to cost." B) "My parents don't know that I'm seeking professional help." C) "My siblings have been pressuring me to start treatment." D) "My job doesn't leave me much time to attend therapy

B) "My parents don't know that I'm seeking professional help." Feedback: Although beliefs regarding mental health issues and treatment can vary among individuals, some Asian cultures have a tradition of denying or disguising the existence of such disorders. Families may be embarrassed to have a member treated for mental illness, which may explain the extremely low utilization of mental health services. Issues of cost and access apply to most cultural groups and are of particular concern to individuals living in poverty or with lower incomes.

A nurse is providing care to a client who is hospitalized with a diagnosis of schizophrenia. Which statement would be appropriate for the nurse to include in the client's medical record? A) "Client states having had a good night with no issues." B) "Reports being unable to sleep because of voices heard throughout the night." C) "Had a typical night without incidence of insomnia or nightmares." D) "Acted crazily throughout the night; kept hearing voices and noises."

B) "Reports being unable to sleep because of voices heard throughout the night." Feedback: The most appropriate statement to record is, "Reports being unable to sleep because of voices heard throughout the night." This statement clearly depicts the client's problem and the reason why. The nurse should avoid jargon and stereotypical statements, such as having a good night with no issues or acting crazily. Only meaningful, accurate, objective descriptions of the behavior should be used.

A client is going to be discharged this afternoon from the mental health unit. The client asks the nurse if a copy of the medical record could be sent to the outpatient psychologist. Which response by the nurse is appropriate? A) "Sure, we'll have that information sent out in today's mail." B) "You will need to sign written authorization for us before we can do this." C) "I think it would be best if you told your psychologist everything directly." D) "How are you feeling about being discharged this afternoon?"

B) "You will need to sign written authorization for us before we can do this." Feedback: The release of information related to psychotherapy requires client permission. The underlying intent is to prevent the release of information to agencies not related to health care, such as employers, without the client's consent. For information to be released, HIPAA regulations require client authorization.

A client is involuntarily committed without a court order. The nurse understands that the emergency, short-term hospitalization can occur for how long? A) A maximum of 24 hours B) 48 to 92 hours C) 3 to 5 days D) 1 week

B) 48 to 92 hours Although commitment procedures vary among states, most have provisions for an emergency, short-term hospitalization of 48 to 92 hours authorized by a certified mental health provider without a court order. At the end of that period, the individual must either agree to voluntary treatment or extended commitment procedures are initiated. This information makes all the remaining options incorrect.

The nurse is screening clients for risk factors associated with limited or no access to health care. Which client should the nurse identify as having the highest risk? A) A 5-year-old child who lives in the city and requires treatment for leukemia B) A 10-year-old child who lives on a farm and requires treatment for depression C) The 23-year-old client who is a veteran and requires treatment for post- traumatic stress disorder (PTSD) D) The 20-year-old client who is homeless and requires treatment for diabetes mellitus

B) A 10-year-old child who lives on a farm and requires treatment for depression Feedback: The nurse should identify the child who lives on a farm and has depression as having the highest risk for limited or no access to health care. People who live in rural areas and especially children with mental health needs have higher risks of limited to no access for care. Even the client who is homeless would be able to access care for diabetes through many services that are offered. The veteran could receive government assisted care, and the child with leukemia could also receive free care through facilities like the Shriner's hospital.

A nurse is caring for a forensic client who is unfit to stand trial. After one year of hospitalization, which intervention is next for this client? A) The client is discharged on probation. B) A judge reviews the facts and rules on the case. C) A civil commitment is initiated by the hospital. D) The client remains hospitalized for another year.

B) A judge reviews the facts and rules on the case. Feedback: An individual cannot be "unfit" forever. If fitness cannot be attained within one year, a hearing must be held and the facts of the alleged crime are presented to a judge who rules on the case. If the charges are dismissed, the judge could order a civil commitment. If there is sufficient evidence to convict, the individual could be sent back to the hospital for further treatment to attain fitness. The maximum length of this additional treatment is based on the severity of the charge.

A nurse performs behaviors that the treatment team would like the client to develop. The client internalizes these behaviors through pervasive imitation. The treatment team is integrating which cognitive theory in the client's treatment? A) Erikson's model of psychosocial development B) Albert Bandura's social cognitive theory C) Skinner's operant conditioning D) Freud's psychoanalytic model

B) Albert Bandura's social cognitive theory Feedback: Bandura developed his ideas after being concerned about violence on television contributing to aggression in children. He believes that important behaviors are learned by internalizing the behaviors of others. His initial contribution was identifying the process of modeling: pervasive imitation, or one person trying to be similar to another. Erickson identified eight stages of psychosocial development. Skinner proposed that if a behavior is reinforced or rewarded, the behavior will probably be repeated. Freud's psychoanalytic model identified the human mind as composed of conscious and unconscious mental processes.

Which client would a nurse determine to be the most likely candidate for involuntary commitment? A) A 24-year-old client who refuses to take the prescribed medication B) An elderly client who is screaming obscenities in the street and disturbing neighbors C) A teenager who refuses to participate in the planned therapy D) A 45-year-old client who is homeless and has been diagnosed with a mental disorder

B) An elderly client who is screaming obscenities in the street and disturbing neighbors Feedback: A client who is screaming obscenities is more likely to be judged as a danger to oneself or to others. Clients have a right to refuse medications or to not participate in therapy in many states and provinces. Being homeless or refusing medication or therapy do not pose an immediate danger to oneself or to others.

A nurse is integrating Peplau's model when providing care to a client with a mental illness. Which would the nurse identify as a key component? A) Suffering B) Anxiety C) Self-care D) Nonverbal behaviors

B) Anxiety Feedback: Anxiety is a key concept of Peplau's model. According to her, anxiety is the energy that arises when expectations that are present are not met. If anxiety is not recognized, it continues to rise and escalates toward panic. Suffering and nonverbal behaviors are not addressed with Peplau's model. Orem focused on self-care.

A psychiatric-mental health nurse is providing care to a client diagnosed with depression. The nurse determines that a client is competent when the client is able to engage in what action? A) Speak coherent English B) Communicate his or her choice C) Write a "living will" D) Comply with the medical regimen

B) Communicate his or her choice Feedback: A client who is competent and able to give informed consent should be able to communicate choices, understand relevant information, appreciate the situation and its consequences, and use a logical thought process to compare the risks and benefits of treatment. The ability to speak coherent English, write a living will, or comply with the medical regimen are not criteria for competence.

During an assessment, a client states, "We rely on our large extensive family for moral support and help and we treat our elders with a great deal of respect. If someone gets sick, the family takes care of them." The nurse interprets this statement as an indication of what? A) Acculturation B) Cultural identity C) Cultural competence D) Linguistic competence

B) Cultural identity Feedback: Everyone has a cultural identity or a set of cultural beliefs with which one looks for standards of behavior. The client's statements reflect their cultural identity. Acculturation refers to the socialization process by which minority groups learn and adopt selective aspects of the dominant culture, eventually leading to the evolvement of a new minority culture (one that is different from the native culture and different from the dominant culture). Cultural competence is the nurse's ability to interact effectively with clients from different cultures. Linguistic competence is the capacity to communicate effectively and convey information that is easily understood by diverse audiences.

A student nurse has been asked by the psychiatric-mental health instructor to plan educational interventions for a forensic client. The client is scheduled for a court hearing. Which activity would be most important for the student nurse to include in the plan? A) Explaining the genetic and neurologic factors associated with criminal behavior B) Describing information about pertinent legal and court proceedings that are pending C) Explaining how nutrition and exercise can promote physical and mental well being D) Providing a list of community providers that the client's family members can contact for assistance and support

B) Describing information about pertinent legal and court proceedings that are pending Feedback: An understanding of the legal proceedings is essential for any person charged with crimes. Court process counseling educates mentally ill clients about impending legal procedures and prepares them for courtroom appearances. This intervention is used for all forensic clients, including those preparing for their fitness to stand a trial hearing, as well as those preparing for discharge. Factual information such as roles and functions of key courtroom personnel, potential pleas that might be offered in court, and the nature of the legal process are basic to this intervention. Fitness issues are discussed as appropriate.

The nurse is developing the care plan for a client diagnosed with a substance abuse disorder using person-centered care. Which intervention(s) should the nurse include in the client's plan of care? Select all that apply. A) Refer the client for inpatient therapy. B) Determine if the client would prefer to have family members involved in the plan. C) Assess the client's willingness to participate in recovering. D) Provide the client with a list of a support groups available in the community. E) Educate the client about how addiction works in the body.

B) Determine if the client would prefer to have family members involved in the plan. C) Assess the client's willingness to participate in recovering. D) Provide the client with a list of a support groups available in the community. The nurse using person-centered care should focus on health needs and expectations instead of the disease. Educating the client about how addiction works in the body and referring the client for inpatient care are not actions that encompass person-centered care. Providing a list of support groups, assessing the client's willingness to change, and providing the client the choice to include the client's family are all actions that support the concept of person-centered care.

The nurse is assessing a client in the emergency department who appears disheveled and anorexic and is malodorous. The client states, "I do not need your help, I am doing just fine on my own. Besides, nobody wants to give a crazy person a job or apartment." Which action(s) should the nurse take? Select all that apply. A) Discuss implementing a paternalistic model of care with the health care provider. B) Focus on implementing person-centered care. C) Assist the client with identifying safe housing options. D) Establish a therapeutic nurse-client relationship. E) Document self-stigma as a barrier to the client's recovery.

B) Focus on implementing person-centered care. C) Assist the client with identifying safe housing options. D) Establish a therapeutic nurse-client relationship. E) Document self-stigma as a barrier to the client's recovery. Feedback: The nurse should recognize that this client is homeless, has a lack of services, possibly has mental health issues and is self-stigmatizing. Person-centered care would be more beneficial for this client, so the client can participate in health care decisions. The paternalistic model would mean the nurse and health care provider would make decisions for the client that they felt were best.

A nurse is watching a video that depicts a client and therapist interacting. The client is asked to say whatever comes to the client's mind. The nurse identifies this technique using what term? A) Dream work B) Free association C) Gestalt therapy D) Classical conditioning

B) Free association Feedback: The video is depicting free association, as described by Freud, in which a person verbalizes spontaneous, uncensored words of whatever comes to mind. Dream work refers to the interpretation of dreams as part of psychoanalysis. Gestalt therapy involves individual and group exercises to bring unmet needs into awareness. Classical conditioning refers to behavior that occurs in response to a stimulus.

A group of nurses is reviewing the various theories that form the basis for psychiatric-mental health nursing. The nurses demonstrate understanding of these theories when they identify which theorists as addressing female development? Select all that apply. A) Maslow B) Gilligan C) Bandura D) Miller E) Thorndike

B) Gilligan D) Miller Feedback: Both Gilligan and Miller addressed female development, identifying that females develop differently from males. Maslow focused on a hierarchy of needs, Bandura focused on learning through the internalization of behaviors of others, and Thorndike focused on reinforcement of positive behavior as important for learning.

A nurse is preparing to administer an as-needed (PRN) medication. What would the nurse need to keep in mind when documenting its administration? A) It requires a separate entry that includes reason for administration, dosage, route, and response to the medication the first time it is administered to a client. B) It requires a separate entry that includes reason for administration, dosage, route, and response to the medication every time it is administered to a client. C) It requires a separate entry that includes reason for administration, dosage, and route the first time it is administered to a client. D) It requires a separate entry that includes reason for administration, dosage, and route every time it is administered to a client.

B) It requires a separate entry that includes reason for administration, dosage, route, and response to the medication every time it is administered to a client. Feedback: Medications prescribed on a PRN basis require a separate entry, including reason for administration, dosage, route, and response to the medication. Documenting responses is the only way to document treatment outcomes, and because the outcome may be different each time, the response along with the reason for administration, dosage, and route should be documented every time the PRN medication is given.

After educating a group of students on the beliefs associated with the world's major religions, the instructor determines that additional teaching is needed when the students identify which belief as associated with Confucianism? A) People are born good. B) People are assigned to castes. C) Authority figures are respected. D) Self-responsibility leads to improvement.

B) People are assigned to castes. Feedback: Caste assignment reflects Hinduism. According to Confucianism, people are born good; authority figures and parents are respected; and improvement is gained through self-responsibility, introspection, and compassion for others.

A group of nurses is preparing an in-service presentation about culture and mental illness. When describing cultural explanations, which would the group include? A) Suffering within a cultural group B) Perceived causes for symptoms C) Social factors contributing to the disorder D) Ability to communicate effectively

B) Perceived causes for symptoms Feedback: A cultural explanation refers to the perceived causes of the symptoms. A cultural idiom of distress describes the suffering within a cultural group. Cultural explanations do not describe the social factors contributing to a disorder. Linguistic competence is the capacity to communicate effectively and convey information that is easily understood by diverse audiences.

A nurse is assessing a client diagnosed with anxiety and observes the client yelling and screaming. The nurse, integrating Peplau's theory, describes this behavior using what term? A) Panic behaviors B) Relief behaviors C) Empathetic linkage D) Social distance

B) Relief behaviors Feedback: According to Peplau, behavioral cues related to the levels of anxiety are "relief behaviors." Panic is the most severe form of anxiety manifested by an inability to function. Empathetic linkage is the ability to feel in oneself the feelings experienced by another person. Social distance is a concept associated with formal and informal support systems. It is the degree to which the values of the formal support organization and primary group members differ.

The nurse is reviewing the medical record of a forensic client who has been found not guilty by reason of insanity. Which statement represents the meaning of this outcome? A) The client knows that a wrongful act was committed. B) The client is unable to control actions at the time of the crime. C) The client is unable to assist in the defense. D) The client's mental illness is a factor in the crime.

B) The client is unable to control actions at the time of the crime. Feedback: A possible outcome or disposition of a hearing or trial is not guilty by reason of insanity (NGRI). The accused person is judged to not know right from wrong or to be unable to control his or her actions at the time of the crime. A defendant is found unfit to stand trial (UST) if, because of a mental or physical condition, he or she is unable to understand the nature and purpose of the proceedings or to assist in the defense. Guilty but mentally ill (GBMI) is a criminal conviction in which mental illness is considered a factor in the crime, but not to the extent that the individual is incapable of knowing right from wrong or controlling his or her actions.

The nurse at a local clinic is caring for several clients. Which client should the nurse recognize as being homeless and unsheltered? A) The client who sleeps in a friend's car at night B) The client sleeping in a sleeping bag under a tree in the park C) The client who looks for coins at the beach all day and sleeps on a bench in the pavilion D) The client who sleeps in a tent during the day and at night digs through trash cans for food

B) The client sleeping in a sleeping bag under a tree in the park The nurse should recognize the client sleeping under a tree in the park has unsheltered homelessness. The other clients all have some type of roof over them to protect them from rain or snow while they sleep. A tree would not be considered shelter.

A nurse is giving a public presentation on the topic of forensic psychiatric care at a community center. The nurse explains that someone who is found to be unfit to stand trial is subsequently hospitalized in a forensic mental health facility. A member of the audience asks, "What is the purpose of the hospitalization?" Which response by the nurse is appropriate? A) To keep the client under protective custody as long as necessary B) To focus efforts on helping the client become fit to stand trial C) To determine the correct diagnosis through treatment D) To hold the client until a new trial date can be set

B) To focus efforts on helping the client become fit to stand trial Feedback: In most states, when a mentally ill individual is found unfit to stand trial (UST), hospitalization in a forensic mental health facility follows. The goal of this hospitalization is to help the person become fit to stand trial, not to treat the mental illness.

A client is being discharged from the psychiatric unit this afternoon, and a nurse needs to teach the client about discharge medications. The client is exhibiting signs of moderate anxiety about the upcoming discharge. Based on Peplau's views regarding anxiety, the nurse would expect to implement the education plan at which time? A) When the client's anxiety stabilizes at its current level B) When the client's decreases to a mild level C) When the client is completely free of anxiety D) When the client's anxiety escalates to the panic level

B) When the client's decreases to a mild level Feedback: Mild anxiety is useful for learning; therefore, it would be appropriate to begin educating the client when anxiety decreases to a mild level. Severe anxiety interferes with learning. Anxiety should be relieved as much as possible, but it would be unrealistic to expect that the client would become completely free of anxiety.

While working in a community mental health treatment center, a nurse overhears one of the receptionists saying that one of the clients is "really psycho." Later in the day, the nurse talks with the receptionist about the comment. This action by the nurse demonstrates an attempt to address which issue? A) lack of knowledge B) public stigma C) label avoidance D) self-stigma

B) public stigma Feedback: The receptionist's statement reflects the negative effects of stigmatization—more specifically, public stigma. Self-stigma reflects a person's internalization of a negative stereotype; that is, the person with the mental illness begins to believe that he or she is what the public thinks he or she is. Label avoidance refers to avoiding treatment or care so as not to be labeled mentally ill. Lack of knowledge is often the underlying theme associated with any type of stigma.

During an interview, a client tells the nurse, "I have developed a new, strong feeling of being connected to the universe." The nurse interprets this statement as an indication of what? A) meaning B) self-transcendence C) cultural identity D) religiousness

B) self-transcendence Self-transcendence, one of the five attributes of spirituality, is characterized by an appreciation of a dimension beyond oneself. Another of the attributes, meaning is the discovery of a sense of purpose in life. Religiousness refers to the participation in a community of people who gather around common ways of worshiping. Cultural identity is a set of cultural beliefs with which one looks for standards of behavior.

A psychiatric-mental health nurse is documenting information in a client's medical record. Which would be least likely to increase the nurse's legal liability? A) "Client reported feeling better today than yesterday." B) "Administered haloperidol 10 mg IM stat as ordered for agitation." C) "Client was talking with another staff member and started screaming." D) "Applied restraints to all four client's extremities."

B. "Administered haloperidol 10 mg IM stat as ordered for agitation." Feedback: The entry about medication administration is the most complete and clear because it states the name of the medication, the dosage and route, and why it was administered. The nurse would then be responsible for following up this documentation with information about how the client responded to the medication. The statement about the client feeling better and the statement about talking with a staff member and screaming are both vague and general. The statement about applying restraints is incomplete. The statement needs to include information about why the restraints were applied, that an order was obtained for the restraints, and how the client responded to the restraints.

A nurse is explaining recovery to the family of a client diagnosed with a mental disorder. Which statement about this process would be most appropriate for the nurse to include? A) "It is a step-by-step process from being ill to being well." B) "The client focuses mainly on the emotional aspects of his condition." C) "The client is helped to live a meaningful life to the fullest potential." D) "Although peer support is important, the self-acceptance is essential."

C) "The client is helped to live a meaningful life to the fullest potential." Feedback: Recovery from mental disorders and/or substance use disorders is a process of change through which individuals improve their health and wellness, live a self directed life, and strive to reach their full potential. It is a nonlinear process with setbacks. It also is strength-based. Peer support is important, but so is respect by the community and consumers, along with self-acceptance to ensure inclusion and participation in all aspects of life.

A psychiatric-mental health nurse is preparing a review class for a group of colleagues on the various theoretical models used in psychiatric-mental health nursing. When describing cognitive theories, which statement would the nurse practitioner most likely include about what these theories attempt to do? A) "They explain development of the mental processes and effects on behavior." B) "They describe how people learn and act." C) "They link internal thought processes with behavior." D) "They explain normal human growth and development."

C) "They link internal thought processes with behavior." Feedback: Cognitive theories attempt to link internal thought processes with human behavior. Psychodynamic theories attempt to explain mental processes and how they affect behavior. Behavioral theories attempt to describe how people learn and act. Developmental theories attempt to explain normal human growth and development over time.

A client with mental illness who has been arrested has been found unfit to stand trial, and the client is admitted to a forensic mental health facility. The nurse understands that the client can be hospitalized for up to which duration to become "fit?" A) 3 months B) 6 months C) 1 year D) 5 years

C) 1 year Feedback: An individual who is found to be unfit to stand trial cannot be "unfit" forever. If fitness cannot be attained within one year, a hearing must be held, during which the facts of the alleged crime are presented to a judge who rules on the case. If the charges are dismissed, the judge could order a civil commitment. If there is sufficient evidence to convict, the individual could be sent back to the hospital for further treatment to attain fitness. The maximum length of this additional treatment is based on the severity of the charge.

A psychiatric-mental health nurse practitioner is preparing a review class for a group of nurses about conceptual models and theories used in psychiatric-mental health nursing. When describing the major concepts of Jean Watson's theory, which concept would the nurse most likely include? Select all that apply. A) Freedom B) Paradox C) Caritas process D) Rhythmicity E) Caritas field F) Mystery

C) Caritas process E) Caritas field Jean Watson's theory contains three foundational concepts: transpersonal caring, clinical Caritas process (original 10 Caritas processes), and Caritas field. Freedom, paradox, rhythmicity, and mystery are associated with Parse's theory of human becoming.

Within the context of the culture of poverty, what most clearly describes why individuals who are part of this culture become trapped in a downward economic spiral? A) Unemployment causes poverty; a lack of will power and motivation can, in turn, cause unemployment in people who do not have a strong work ethic. B) Individuals lack the finances to pay rent, so they eventually do not have an address to use in filling out job applications. C) Characteristics of poverty (joblessness and lack of financial independence) can contribute to attributes (feelings of powerlessness and low self-esteem) that sustain poverty. D) Poverty is passed on from generation to generation; individuals learn at an early age that there is no way to escape living in poverty.

C) Characteristics of poverty (joblessness and lack of financial independence) can contribute to attributes (feelings of powerlessness and low self-esteem) that sustain poverty. Feedback: Families experiencing poverty are under tremendous financial and emotional stress, which may trigger or exacerbate mental health problems. Along with the daily stressors of trying to provide food and shelter for themselves and their families, the lack of time, energy, and money prevents them from attending to their psychological needs. Often, these families become trapped in a downward economic spiral as tensions and stress mount. The inability to gain employment and the lack of financial independence add to feelings of powerlessness and low self-esteem. Feeling powerless and having low self-esteem have the potential to keep these individuals from trying to find employment.

While working with an older client, a nurse begins to think of the client as a grandparent and responds to the client as a grandchild. The nurse is developing what type of emotional reaction? A) Empathy B) Transference C) Countertransference D) Modeling

C) Countertransference Feedback: The nurse, upon feeling that the client reminds the nurse of a grandparent, is developing countertransference. The nurse is developing an attachment to the client, thus treating the client as a grandparent. Empathy refers to the ability to feel what the client is feeling. Transference is the displacement of the thoughts, feelings, and behaviors originally associated with a significant other from childhood onto a person in a current therapeutic relationship. Modeling is pervasive imitation, or one person trying to be similar to another.

A nurse is assessing a young adult and determines that the individual has achieved successful resolution of the previous stage of growth and development as evidenced by demonstrating which traits? A) Drive and hope B) Direction and purpose C) Devotion and fidelity D) Production and care

C) Devotion and fidelity Feedback: In the stage before young adulthood-adolescence, the young adult would have successfully developed identity, achieving the outcome of devotion and fidelity. A young adult is experiencing a current developmental conflict of intimacy versus isolation, with the ultimate long-term outcome of achieving affiliation and love. Drive and hope are the long-term outcomes of infancy. Direction and purpose are the long-term outcomes of the preschool stage. Production and care are the long term outcomes of adulthood, which the young adult has yet to reach.

The nurse is leading a support group on the mental health unit. Which action should the nurse take first? A) Empower each client to share as much or as little as desired within the group. B) Promote comfort by allowing each client to find a place to sit that makes the client comfortable within the room. C) Establish a connection by greeting each client by name and thanking each for joining the group. D) Encourage each client to invite a peer support person to come with him or her to the group sessions.

C) Establish a connection by greeting each client by name and thanking each for joining the group. Feedback: The nurse should first establish a therapeutic nurse-client relationship by trying to establish trust and a connection with the clients. Person-centered care is built on a strong nurse-client relationship. Greeting each client by name and thanking him or her for joining the group can give each client a sense of importance and belongingness. The other options would be appropriate to do after establishing a connection.

An advance care directive is listed on a psychiatric-mental health client's medical record. A clinician provides treatment that disregards the client's directive. The clinician would be liable for which legal tort? A) Assault B) Battery C) Medical battery D) False imprisonment

C) Medical battery Feedback: Failure to respect a client's advance care directive is considered medical battery. Assault is the threat of unlawful force to inflict bodily injury on another. Battery is intentional and unpermitted contact with another. False imprisonment is detention or imprisonment contrary to the provision of law.

A group of nurses is reviewing information about internal rights protection systems. The nurses demonstrate understanding of this information when they identify which example? A) American Hospital Association B) American Public Health Association C) State mental health provider D) The Joint Commission

C) State mental health provider Feedback: Mental health care systems have internal rights protection systems or mechanisms to combat any violation of their clients' rights. Each state mental health provider is required to establish and operate a system that protects and advocates for the rights of individuals with mental illnesses. The American Hospital Association and American Public Health Association serve as advocates for the rights and treatment of mental health clients and are part of an external advocacy system. Clients' rights are also assured of protection by an agency's accreditation, such as accreditation by The Joint Commission.

A psychiatric-mental health nurse is preparing to practice in a rural region. What should the nurse understand about mental health issues and services in rural cultures? A) Mental health disorders are less common compared to urban areas. B) Suicide rates are roughly equal to those in urban settings. C) There tends to be limited access to mental health care. D) People living in rural cultures tend not to be receptive to mental health

C) There tends to be limited access to mental health care. Feedback: Most mental health services exist in urban settings; with fewer services, those in rural settings generally have less access to health care. While this lack of access leads to fewer mental health diagnoses, this lower rate of diagnosis does not necessarily indicate a lower incidence of mental health disorders. Rural areas are diverse in culture, so while some treatment approaches may be favored in some locations compared to others, any statement that rural cultures are unreceptive to mental health care is unsupported. Suicide rates in rural areas are higher than those in urban areas, with firearms most commonly used.

The nurse is caring for a client diagnosed with depression who was admitted for a substance abuse disorder. The nurse is using recovery oriented nursing care. Which goal would be the most appropriate for the client's care? A) To prevent re-admission B) To have the client achieve stigma resilience C) To empower the client to maintain recovery D) To provide person-centered care

C) To empower the client to maintain recovery Feedback: The most appropriate goal would be to empower the client to maintain recovery. Using person-centered care would assist with achieving the goal and with achieving stigma resilience. If the client can maintain the goal of recovery than that would prevent re-admission.

The nurse is caring for a client who wants to actively participate in the plan of care. Which action should the nurse take? A) Discuss the informed choice model with the client. B) Include the concept of empowerment when planning the client's care. C) Use the shared decision-making model when planning the client's care. D) Discuss the paternalistic model with the client.

C) Use the shared decision-making model when planning the client's care. Feedback: The nurse should include use of the shared decision-making model when planning the client's care because this approach allows the individual to be an active participant in planning care. The paternalistic model does not allow active participation; it is based on the nurse/health care provider making choices thatperson feels are best for the client. The informed choice model allows the client to choose after the nurse/health care provider provides evidence of treatments and care and offers options to the client. However, this is not a collaborative effort; the client makes all the choices alone based on the information provided. Empowerment is a concept that is used to support clients not to collaboratively plan care with the client.

A nurse is working as part of a multidisciplinary team and developing a plan of care for a client who is receiving recovery-oriented treatment. Which would the nurse integrate into this plan? A) Focusing primarily on the mind B) Limiting support from others C) Using hope as motivation D) Avoiding underlying trauma

C) Using hope as motivation Recovery emerges from hope. The belief that recovery is real provides the essential and motivating message of a better future—that people can and do overcome the internal and external challenges, barriers, and obstacles that confront them. Recovery is also holistic, addressing an individual's whole life, including body, mind, spirit, and community. Recovery is supported by peers and allies and through relationships and social networks. Finally, recovery is supported by addressing trauma, such that services and supports should be informed by trauma to foster safety.

After educating a group of students on mental health and mental illness, the instructor determines that the education was successful when the group identifies what as reflecting mental disorders? A) capacity to interact with others B) ability to deal with ordinary stress C) alteration in mood or thinking D) lack of impaired functioning

C) alteration in mood or thinking Feedback: Mental disorders are health conditions characterized by alterations in thinking, mood, or behavior and are associated with distress or impaired functioning. Mental health is the emotional and psychological well-being of an individual who has the capacity to interact with others, deal with ordinary stress, and perceive one's surroundings realistically.

During an interview, a client states, "God does not exist for me." The nurse interprets this statement as reflecting what belief? A) animism B) agnosticism C) atheism D) polytheism

C) atheism Feedback: Atheism is the belief that no God exists, as "God" is defined in any current existing culture of society. Animism reflects the belief that souls or spirits are embodied in all beings and everything in nature. Agnosticism is the belief that whether there is a God and spiritual world (or any ultimate reality) is unknown and probably unknowable. Polytheism is the belief in many gods and in the basic powers of nature.

A nurse is working in a community mental health center that provides care to a large population of people of Asian descent. When developing programs for this community, which would be most important topic for the nurse to address? A) public stigma B) self-stigma C) label avoidance D) negative life events

C) label avoidance Feedback: Although public stigma and self-stigma may be areas needing to be addressed, in this cultural group, label avoidance would be most important. Label avoidance or avoiding treatment/care so as not to be labeled mentally ill is a type of stigma that influences why so few people with mental health problems actually receive assistance. Asian cultures commonly have negative views of mental illness that influence the willingness of members to seek treatment; they possibly ignore the symptoms or refuse to seek treatment because of this stigma. Negative life events affect anyone, not just those of the Asian culture

Which would be a major barrier affecting the treatment of individuals diagnosed with mental health problems? A) lack of diagnostic criteria B) inability to obtain epidemiologic data C) stigma associated with mental health problems D) limited hope for recovery

C) stigma associated with mental health problems Feedback: Stigma is one of the major treatment barriers facing individuals with mental health problems and their families. Diagnostic criteria have been established for mental disorders, and evidence through epidemiologic research provides valuable information about the mental health status of population groups and associated factors. A guiding principle of recovery is hope, the belief that recovery is real and that people can and do overcome the internal and external challenges, barriers, and obstacles confronting them.

The nurse is caring for a group of clients at a substance abuse disorder treatment facility. Which statement would indicate a client is experiencing self- stigma? A) "Every time I am outside getting fresh air, I can feel people who are walking by just staring at me. I almost did not come back in." B) "I cannot wait to prove to my family that I am not using drugs anymore, but I know they are just going to see me as an addict forever." C) "I understand that I need to find a new group of friends, because my friends will keep offering me drugs instead of helping me stay off of them." D) "How do I get my coworkers to understand that I have a disease and it is not a choice? Their whispers make me want to leave work and find drugs."

D) "How do I get my coworkers to understand that I have a disease and it is not a choice? Their whispers make me want to leave work and find drugs." Feedback: The client statement about wanting to leave work and use drugs because of the coworkers' whispering is an indication of self-stigma. The client is internalizing thecoworkers' opinions and it increases the client's symptoms of wanting to use drugs. The other statements are indications that the client is overcoming other people's opinions.

The nurse is interviewing a client diagnosed with a mental illness. The nurse determines that the client is experiencing label avoidance when the client makes what statement? A) "I'm at the cause of my illness." B) "I'll never be able to function in the world." C) "I'm as crazy as everybody thinks I am." D) "I really don't need professional help."

D) "I really don't need professional help." Feedback: Label avoidance involves an individual not seeking treatment so as not to be labeled as mentally ill. The statement about not really needing to see anyone suggests label avoidance. The statements about being the cause of the illness, not being able to function in the world, and being as crazy as everyone says reflect self-stigma, the internalization of negative stereotypes by individuals with mental illness.

A client is being treated for prostate cancer; his prognosis is very poor. The client has a strong faith, and he has been active in his church for many years. He is concerned about his health and the challenges he faces as his cancer progresses. Which comment by the nurse reflects the most appropriate spiritual nursing intervention for this client? A) "I'll take you to visit my church if you can get a pass." B) "If you picked the right church, you should go to Heaven." C) "Would you like me show you a guided imagery app for your phone?" D) "We can pray together if you'd like."

D) "We can pray together if you'd like." Feedback: To carry out spiritual interventions, the nurse enters a therapeutic relationship with the client and uses the self as a therapeutic tool. Assuming that the nurse can do so genuinely, offering to pray with this client is the best intervention that allows the nurse to act as a therapeutic tool. Although guided imagery is an appropriate spiritual intervention in many cases, it is unlikely to be as strong a tool in this scenario given this client's strong religious background. Suggesting that the client attend the nurse's church may inappropriately impose the nurse's belief system on the client. Saying that the client will "go to Heaven" if he chose the correct church is unsupportive; it potentially casts doubt on the client's belief system and may reinforce doubt and anxiety.

A nurse is caring for a client who is hospitalized for a mental disorder. The nurse is legally obligated to breach the client's confidentiality if the client makes which statement? A) "I think that the federal government is spying on me." B) "I get really 'turned on' by your appearance." C) "That doctor I had today really made me angry." D) "When I get out of here, I'm going to make my neighbor sorry."

D) "When I get out of here, I'm going to make my neighbor sorry." Feedback: When there is suspicion that a client has harmed someone or is about to injure someone, a nurse is mandated to breach confidentiality and report this to the authorities. The statement "I'm going to make my neighbor sorry" is an example. Thinking that the federal government is spying on the person reflects paranoid thinking. The statement about being "turned on" reflects manipulative behavior. The statement about feeling angry about the doctor provides information about the client's feelings. The nurse would be mandated to report this statement only if the client went on to say that he or she was planning to "hurt" the doctor.

A group of nursing students is reviewing information about spirituality and religiousness. The group demonstrates understanding when they identify religiousness as what? A) A feeling of connectedness B) A way of interpreting life events C) A relationship with a unifying force D) Community participation in common worship

D) Community participation in common worship Feedback: Religiousness refers to participation in a community of people who gather around common ways of worshiping. Spirituality refers to feelings of connectedness with God, spirit, nature, or a unifying force, and is a way of interpreting life events.

A nurse is assessing a client to evaluate the client's mental health and wellness. Applying the eight dimensions of wellness, which would the nurse identify as reflecting emotional wellness? A) Finding ways to expand creative abilities B) Recognizing the need for sleep and nutrition C) Searching for meaning in life D) Developing skills for dealing with stress

D) Developing skills for dealing with stress Feedback: The emotional dimension of wellness focuses on developing skills and strategies to cope with stress. The intellectual dimension focuses on recognizing creative abilities and finding ways to expand one's knowledge and skills. The physical dimension focuses on recognizing the need for physical activity, diet, sleep, and nutrition. The spiritual dimension focuses on the search for meaning and purpose in the human experience.

A psychiatric-mental health nurse is integrating Carl Rogers's theory into the plan of care for a client with a mental illness. The nurse incorporates understanding of this theory through which action? A) Providing validation of the terminology used during the session B) Focusing on the client's instinctual drives C) Recognizing an understanding of the client's basic needs D) Developing unconditional positive regard for the client

D) Developing unconditional positive regard for the client Feedback: Carl Rogers advocated developing unconditional positive regard for the client (i.e., a nonjudgmental caring for the client). Genuineness of the therapist was also an important factor. Rogers did not address validation, instinctual drives, and basic needs.

After educating a class on competency and how it is assessed, the nursing instructor determines the need for additional instruction when the class identifies which ability as being evaluated? A) Communication of choices B) Understanding of relevant information C) Appreciation for a situation and its consequences D) Discussion of what is right and wrong

D) Discussion of what is right and wrong A client who is competent is able to communicate choices, understand relevant information, appreciate the situation and consequences, and use a logical thought process to compare risks and benefits of treatment options. The ability to discuss what is right and wrong is not a component assessed when determining competency.

A group of nursing students is reviewing information about Freud's personality structure. The students demonstrate understanding of this information when they identify the ability to form mutually satisfying relationships as a function of what element of personality? A) Defense mechanisms B) Unconscious C) Id D) Ego

D) Ego Feedback: In Freud's personality structure, the ability to form mutually satisfying relationships is a fundamental function of the ego and is formed throughout a child's development. Defense mechanisms are coping styles that protect a person from unwanted anxiety. The unconscious refers to feelings and thoughts outside awareness and not remembered. The id is formed by unconscious desires, primitive instincts, and unstructured drives.

A psychiatric nursing instructor is trying to explain to a group of students how clients identified as guilty but mentally ill (GBMI) and not guilty by reason of insanity (NGRI) differ. Which statement is appropriate for the instructor to include in the discussion? A) GBMI clients are treated in a hospital setting and are often discharged sooner than NGRI clients. B) NGRI clients are treated in a correctional setting and are discharged sooner than GBMI clients. C) GBMI clients are treated in a hospital setting and their discharge is handled through the correctional parole system. D) NGRI clients are treated in a hospital setting and their discharge is determined by the courts.

D) NGRI clients are treated in a hospital setting and their discharge is determined by the courts. Feedback: Both GBMI and NGRI persons are treated for their mental illness, but whereas individuals found to be GBMI are treated in the correctional system, individuals who are NGRI are ordered to a forensic facility for a psychiatric evaluation and treatment recommendations. Nearly all individuals found NGRI are also subject to involuntary commitment in a secure setting. The conditions of release are different. Whereas individuals with a GBMI are subject to the correctional system's parole decisions, an NGRI individual is discharged from the hospital through the courts upon recommendations by forensic mental health professionals.

A nursing student is assigned to care for a client diagnosed with schizophrenia. When talking about this client in a clinical post-conference, the student would use which terminology when referring to the client? A) Committed client B) Schizophrenic C) Schizophrenic client D) Person with schizophrenia

D) Person with schizophrenia Feedback: Just as a person with diabetes should not be referred to as a "diabetic" but rather as a "person with diabetes," a person with a mental disorder should never be referred to as a "schizophrenic" or "bipolar," but rather as a "person with schizophrenia" or a "person with bipolar disorder." Doing so helps to counteract the negative effects of stigma.

After educating a class of nursing students about the rights of persons receiving mental health services, the instructor determines a need for additional instruction when the students identify which as a right? A) Freedom from restraints or seclusion B) Access to one's own mental health records upon request C) An individualized written treatment plan D) Refusal of treatment during an emergency situation

D) Refusal of treatment during an emergency situation Feedback: The Bill of Rights for persons receiving mental health services includes the right to be free from restraints or seclusion, to access one's own mental health care records upon request, to have an individualized written treatment plan, and to refuse treatment except during an emergency situation.

When integrating the Neuman systems model while caring for a client diagnosed with a mood disorder, which would a nurse focus on with regard to the client? A) Behaviors B) Relationships C) Self-care activities D) Stressors

D) Stressors Feedback: The Neuman systems model focuses on the client system interacting with the environment. Neuman was one of the first psychiatric nurses to include the concept of stressors in understanding nursing care. Behaviors, relationships, and self-care activities would not be addressed.

A nurse is preparing a presentation about mental health problems associated with specific ethnic and cultural groups. When describing mental health problems associated with American Indian/Alaska Native adolescents, the nurse would address high rates of which of the following? A) Schizophrenia B) Manic disorders C) Dementia D) Suicide

D) Suicide Feedback: Research regarding specific mental health problems suggest that rates of suicide for American Indian/Alaska Native adolescents are higher than those of other adolescents in the United States . The data doesn't support the other options.

When reviewing several studies about the use of mental health care facilities among Latinx Americans, the nurse notes that this cultural group tends to use all other resources before seeking help from mental health professionals. Which of the following would the nurse identify as a reason for this belief about many mental health facilities? A) They require periods of hospitalization. B) They do not provide 24-hour emergency services. C) They are not reimbursed by third-party payers. D) They do not accommodate their cultural needs.

D) They do not accommodate their cultural needs. Feedback: Studies reveal that Latinx Americans are reluctant to seek mental health services, possibly because they believe that those services do not accommodate their cultural needs (e.g., language, beliefs, values), because of the cost of care, and because of concerns regarding immigration status. Many instead seek help through supportive family services and the church. Required hospitalization, lack of 24-hour emergency services, and lack of reimbursement do not play a role.

A nurse is describing the four dimensions of recovery to a group of new psychiatric-mental health nurses. Which dimension is the nurse describing when addressing relationships and social networks? A) health B) home C) purpose D) community

D) community Four dimensions support recovery: health (managing disease and living in a physically and emotionally healthy way), home (a safe and stable place to live), purpose (meaningful daily activities and independence, resources, and income), and community (relationships and social networks).

The nurse is documenting a specific pattern of symptoms that occurs within a community. What term will the nurse use? A) stigma B) wellness C) stereotype D) cultural syndrome

D) cultural syndrome Feedback: A cultural syndrome refers to a specific pattern of symptoms that occurs within a specific cultural group or community. Stigma refers to a mark of shame, disgrace, or disapproval that results in an individual being shunned or rejected by others. A stereotype is a mistaken or oversimplified representation of a group held by those outside that group. Wellness is a purposeful process of individual growth, integration of experience, and meaningful connection with others. It reflects personally valued goals and strengths, and results in being well and living by values.

A psychiatric-mental health nurse is preparing a presentation about recovery for a group of newly hired nurses at a mental health facility. Which concept would the nurse identify as crucial to recovery? A) self-direction B) peer support C) respect D) hope

D) hope Feedback: Although self-direction, peer support, and respect are fundamental components of recovery, hope (the catalyst of the recovery process) is a crucial concept. It is through hope that individuals and families can overcome the barriers and obstacles facing them.

A nurse is reviewing journal articles that discuss the occurrence of major depression. One of the articles describes the number of persons newly diagnosed with the disorder during the past year. The nurse interprets this as which type of data? A) rate B) prevalence C) point prevalence D) incidence

D) incidence Feedback: The article is describing incidence, which refers to a rate that includes only new cases that have occurred within a clearly defined time period. The most common time period evaluated is 1 year. Rate reflects the proportion of cases in the population compared with the total population. Prevalence refers to the total number of people with the disorder within a given population at a specified time, regardless of how long ago the disorder started. Point prevalence refers to the proportion of individuals in the population who have a disorder at a specific point in time.

A psychiatric-mental health nurse is educating a class at a community health center on social factors associated with mental illness. When describing the influence of poverty and effects of the downward economic spiral on mental health, which population would the nurse identify as being the most at risk? A) older adults B) individuals with physical disabilities C) single-parent families D) individuals who are homeless

D) individuals who are homeless Feedback: Poverty affects all cultural groups and other groups such as older adults, people with physical disabilities, individuals with psychiatric impairments, and single parent families. Often, those in poverty become trapped in a downward economic spiral as tensions and stress mount. The homeless population is the group most at risk for becoming unable to escape the spiral of poverty.

After teaching a group of nursing students about recovery, the instructor determines that more education is needed when the group identifies what as a characteristic? A) self-direction in life B) improvement in health and wellness C) achievement of full potential D) one-time change situation

D) one-time change situation Feedback: Recovery from mental disorders and/or substance use disorders is a process of change through which individuals improve their health and wellness, live a self directed life, and strive to reach their full potential.

The nurse is describing the treatment of mental illness with a client's family members. What would a nurse identify as the primary goal? A) functional status B) stigma reduction C) stress reduction D) recovery

D) recovery Although reducing stigma, reducing stress, and improving functional status are important components involved in the treatment of mental illness, recovery is the single most important goal for individuals with mental disorders.