NUR 190 CHP 1, 3,4,5,6 Practice Questions

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15. What is required for a transitional care model to be most effective in promoting the client's health and well-being and prevent relapse and rehospitalization? Select all that apply. A) Collaboration B) Administrative support C) Adequate funding D) Family support E) Completely different providers F) Isolation from peers who successfully live in the community

ANS A,B,C, A) Collaboration B) Administrative support C) Adequate funding Two essential components of transitional care model are peer support and bridging staff. Peer support is provided by a consumer now living successfully in the community. Bridging staff refers to an overlap between hospital and community careóhospital staff do not terminate their therapeutic relationship with the client until a therapeutic relationship has been established with the community care provider. This model requires collaboration, administrative support, and adequate funding to effectively promote the patient's health and well-being and prevent relapse and rehospitalization.

25. Which of the following are core skill areas that are needed of any effective team member of an interdisciplinary team? Select all that apply. A) Interpersonal skills B) Teamwork skills C) Communication skills D) The ability to work independently E) Risk assessment and risk management skills

ANS A,B,C,E A) Interpersonal skills B) Teamwork skills C) Communication skills D) The ability to work independently E) Risk assessment and risk management skills The core skill areas that are needed to function as an effective team member of an interdisciplinary team include interpersonal skills, such as tolerance, patience, and understanding; humanity, such as warmth, acceptance, empathy, genuineness, and nonjudgmental attitude; knowledge base about mental disorders, symptoms, and behavior; communication skills; personal qualities, such as consistency, assertiveness, and problem-solving abilities; teamwork skills, such as collaborating, sharing, and integrating; risk assessment and risk management skills. Members of an interdisciplinary group must work interdependently, not independently.

25. The nurse has been working with a patient with an eating disorder for one week. During the morning treatment team meeting, the treatment plan is updated. Which of the following would be appropriate interventions at this time in the nurseñpatient relationship? Select all that apply. A) Exploring perceptions of reality B) Promoting a positive self-concept C) Explaining the boundaries of the relationship D) Working through resistance E) Assisting in identifying problems

ANS A,B,D A) Exploring perceptions of reality B) Promoting a positive self-concept D) Working through resistance Specific tasks of the working phase include maintaining the relationship, gathering more data, exploring perceptions of reality, developing positive coping mechanisms, promoting a positive self-concept, encouraging verbalization of feelings, facilitating behavior change, working through resistance, evaluating progress and redefining goals as appropriate, providing opportunities for the client to practice new behaviors, and promoting independence. Establishing boundaries and identifying problems are completed in the orientation phase.

7. Discharge planning from inpatient care for people with severe mental illness must address which of the following to be effective? Select all that apply. A) Finding housing for the client B) Finding a job for the client C) Finding transportation for the client D) Improving family support E) Identifying ideal recreational activities

ANS A,C A) Finding housing for the client C) Finding transportation for the client Clinicians help clients recognize symptoms, identify coping skills, and choose discharge supports in the inpatient setting. People are able to remain in the community for longer periods of time when discharge planning addresses environmental supports, housing, transportation, and access to community support services. Finding a job for the client may be helpful if appropriate but may not be appropriate for the individual at the time of discharge from inpatient care. Improving family support and identifying ideal recreational activities are desirable but not essential for successful reintegration with the community.

3. Which of the following statements is true of empathy? Select all that apply. A) It is the ability to place oneself into the experience of another for a moment in time. B) It involves interjecting the nurse's personal experiences and interpretations of the situation. C) It is developed by gathering information from the client. D) It results in negative therapeutic outcomes. E) The client must learn to develop empathy for the nurse.

ANS A,C A) It is the ability to place oneself into the experience of another for a moment in time. C) It is developed by gathering information from the client. Empathy is the ability to place oneself into the experience of another for a moment in time. Nurses develop empathy by gathering as much information about an issue as possible directly from the client to avoid interjecting their personal experiences and interpretations of the situation. It does not result in negative therapeutic outcomes. The nurse must develop empathy with the client.

32. Which element would be present in an assertive community treatment (ACT) program? A) 24-hour-a-day services B) Infrequent contact with clients C) Many clients to each staff member D) Limited length of service

ANS A. 24-hour-a day services ACT includes a 24-hour-a-day service, many staff members for each client, in-home or community services, intense and frequent contact, and unlimited length of service.

4. The nurse asks the patient what he would like to talk about. This is an example of A) broad opening. B) encouraging expression. C) focusing. D) offering self.

ANS A. Broad opening Broad openings allow the client to take the initiative in introducing the topic. Encouraging expression involves asking the client to appraise the quality of his or her experiences. The nurse uses focusing when concentrating on a single point. Offering self occurs when making oneself available.

32. How can a nurse avoid the possibility of finding the client's behavior unacceptable or distasteful? A) By being aware of the client's behavior and background before beginning the relationship; and exploring the possibility of a conflict of a colleague. B) By using silence instead of verbal responses for all instance of the client describing their behavior C) By using facial expressions of annoyance if the client expresses behavior that the nurse disapproves of D) By turning away from the client when the nurse does not want the client to see his or her facial expression

ANS A. By being aware of the client's behavior and background before beginning the relationship; and exploring the possibility of a conflict of a colleague. The nurseñclient relationship can be jeopardized if the nurse finds the client's behavior unacceptable or distasteful and allows these feelings to show by avoiding the client or making verbal responses or facial expressions of annoyance or turning away from the client. The nurse should be aware of the client's behavior and background before beginning the relationship; if the nurse believes there may be conflict, he or she must explore this possibility with a colleague.

18. Which type of psychiatric rehabilitation relies on intentional communities and rehabilitation alliances? A) Clubhouse model B) Assertive community treatment C) Group homes D) Respite housing

ANS A. Clubhouse model The clubhouse model of psychiatric rehabilitation relies on intentional communities and rehabilitation alliances. Assertiveness community treatment (ACT) has a problem- solving orientation, and staff members who are in the community attend to specific life issues of the client. Group homes are a residential form of treatment for mental illness but do not provide complete psychiatric rehabilitation. Respite housing is temporary housing for mentally ill persons and does not provide complete psychiatric rehabilitation.

13. A client who had been in a substance abuse treatment program asks the nurse for a date after the client is discharged. The nurse talks to the client about the importance of a therapeutic relationship and its characteristics. The nurse is using which of the following techniques? A) Defining boundaries B) Defining therapy C) Letting the client down gently D) Reprimanding the client

ANS A. Defining boundaries A therapeutic relationship is professional, and there are no mutual social goals; it is focused on meeting the client's needs and is terminated when the client no longer needs services. It is up to the nurse to maintain professional boundaries. The other choices would be inappropriate techniques to use toward this client.

8. The nurse asks the client what that experience was like. Which communication skill is the nurse using? A) Encouraging expression B) Encouraging description of perceptions C) Exploring D) Requesting an explanation

ANS A. Encouraging expression Encouraging expression is a therapeutic technique and involves asking the client to appraise the quality of his or her experiences. Encouraging description of perceptions is a therapeutic technique and involves asking the client to verbalize what he or she perceives. Exploring is a therapeutic technique that involves delving further into a subject or an idea. Requesting an explanation is a nontherapeutic verbal communication technique that involves asking the client to provide reasons for thoughts, feelings, behaviors, events.

2. Which one of the following goals of therapeutic communication would the nurse strive to attain first? A) Facilitate the client's expression of emotions. B) Establish a therapeutic nurseñclient relationship. C) Teach the client and family necessary self-care skills. D) Implement interventions designed to address the client's needs.

ANS A. Facilitate the client's expression of emotions. Establishing a therapeutic relationship is one of the most important responsibilities of the nurse when working with clients.

2. The factor having the most influence on the current trend in treatment settings is the fact in recent years, A) funding for community programs has been inadequate. B) laws have enabled more people to be committed to treatment. C) state hospitals have expanded to meet the demand. D) community programs have been fully developed to meet treatment needs.

ANS A. Funding for community programs has been inadequate Adequate funding has not kept pace with the need for community programs and treatment. Commitment laws have led to deinstitutionalization. Large state hospitals emptied as a result. Treatment in the community was intended to replace much of state hospital inpatient care, but funding has been inadequate.

14. The nurse fails to assess personal values surrounding homosexuality before caring for a patient who is openly gay. The nurse is most at risk for which of the following when working with this patient? A) Holding a prejudice toward this patient B) Neglecting to include the patient's desires in the plan of care C) Being manipulated by this patient D) Expressing shock when assessing the patient's history

ANS A. Holding a prejudice toward this patient A person who does not assess personal attitudes and beliefs may hold a prejudice or bias toward a group of people because of preconceived ideas or stereotypical images of that group. It is not uncommon for a person to be ethnocentric about his or her own culture. Failure to consider cultural variations or reactions to initial exposure to variations is less detrimental to the therapeutic relationship than cultural bias. Manipulation results from a failure to maintain boundaries.

2. The nurse is working with a patient who has quit several jobs and no longer sends financial support to his two children living with their mother. This behavior is in conflict with the nurse's values concerning responsible parenting. When discussing family roles with the patient, the nurse shows positive regard through which statement? A) ìHow is not working right now affecting you?î B) ìHow do you expect your kids to be provided for?î C) ìYou need to somehow find a way to support your children.î D) ìCan the children's mother can get by for a while until you get better?î

ANS A. How is not working right now affecting you? The nurse who appreciates the client as a unique worthwhile human being can respect the client regardless of his or her behavior, background, or lifestyle. The nurse maintains attention on the client and avoids communicating negative opinions or value judgments about the client's behavior. In using positive regard, the nurse avoids value judgments and shifting of the focus away from the patient.

24. During the orientation phase of the nurseñpatient relationship, the nurse directs the patient to do which of the following? A) Identify problems to examine B) Express needs and feelings C) Develop interpersonal skills D) Identify self-care strategies

ANS A. Identify problems to examine The orientation phase begins when the nurse and client meet and ends when the client begins to identify problems to examine. Expression of feelings and improving interpersonal skills are tasks of the working phase. Self-care strategies are developed and assessed nearing termination.

15. Which one of the following statements about the nurse and ethnocentrism is true? A) Nurses as people may inwardly view their own culture as superior to others. B) Ethnocentrism is a desirable trait in a nurse. C) Nurses must deny their ethnocentrism. D) A nurse must not think of his or her own attitudes and beliefs.

ANS A. Nurses as people may inwardly view their own culture as superior to others. Nurses as people may inwardly view their own culture as superior to others. Ethnocentrism is not uncommon especially when the person has no experience with any culture other than his or her own. It is neither a desirable trait nor an undesirable trait. Nurses must examine their ethnocentrism, and think of their own attitudes and beliefs.

11. What are the two essential components of transitional care discharge model that is used in Canada and Scotland? A) Peer support and bridging staff B) Collaboration and funding C) Relapse and hospitalization D) Poverty and entitlements

ANS A. Peer support and bridging staff Two essential components of the transitional care discharge model are peer support and bridging staff. Peer support is provided by a consumer now living successfully in the community. Bridging staff refers to an overlap between hospital and community careóhospital staff do not terminate their therapeutic relationship with the client until a therapeutic relationship has been established with the community care provider. This model requires collaboration, administrative support, and adequate funding to effectively promote the patient's health and well-being and prevent relapse and rehospitalization. Poverty among people with mental illness is a significant barrier to maintaining housing. Mentally ill persons often rely on government entitlements for their income which forces people to have to choose continuation of the entitlement and dependence versus working inconsistently in unskilled, part-time, and low-paying jobs with no health insurance.

28. A patient with bipolar disorder taking lithium returns from a walk outside and reports feeling shaky and dizzy. The nurse suspects the patient is experiencing a toxic reaction to the lithium and immediately notifies the A) psychiatrist. B) psychologist. C) nurse manager. D) recreation therapist.

ANS A. Psychiatrist The primary function of the psychiatrist is diagnosis of mental disorders and prescription of medical treatments. Psychologists participate in the design of therapy programs for groups of individuals. The nurse is an essential team member in evaluating the effectiveness of medical treatment particularly medications. The recreation therapist helps the client to achieve a balance of work and play.

22. A patient with bipolar disorder has a long history of both hospitalizations and incarcerations. The patient has no permanent residence and has infrequent contact with his family. Upon admission to the inpatient psychiatric unit for stabilization, the nurse documents all of the following in the record. Which of the following data most suggests a positive outcome for this patient? A) Reporting meeting with the same case manager monthly for the last 3 years B) History of residential stays at several local homeless shelters C) Last contact with siblings 4 years ago D) Income from day labor for 10 days last month

ANS A. Reporting meeting with the same case manager monthly for the last 3 years Results are positive when personal connections with case managers are established. The most recent report from the ACCESS project found frequent shifts between the street, programs, and institutions worsen the lives of the homeless. The degree of social support and employment has direct influence on quality of life.

34. Which of the following considerations should have the most influence in the nurse's choice of the treatment for the client? A) The client's feelings and perceptions about his or her situation B) The nurse's beliefs about the theories of psychosocial development C) The nurse's familiarity with the type of treatment D) Any approach to treatment should work with any client.

ANS A. The client's feelings and perceptions about his or her situation The client's feelings and perceptions about his or her situation are the most influential factors in determining his or her response to therapeutic interventions, rather than what the nurse believes the client should do. The nurse must examine his or her beliefs about the theories of psychosocial development and realize that many treatment approaches are available. Different treatments may work for different clients: no one approach works for everyone. Becoming familiar with the variety of psychosocial approaches for working with clients will increase the nurse's effectiveness in promoting the client's health and well-being.

20. A nurse openly admits to not being able to relate to a patient's experience. According to Munhall, this will most likely have what influence on the therapeutic relationship? A) The nurse will avoid imposing any values on the patient. B) The patient will not trust the nurse's professional abilities. C) The nurse will more likely be manipulated by the patient. D) The patient will be less likely to self-disclose to the nurse.

ANS A. The nurse will avoid imposing any values on the patient Munhall added another pattern of knowing called unknowing: For the nurse to admit she or he does not know the client or the client's subjective world opens the way for a truly authentic encounter. The nurse in a state of unknowing is open to seeing and hearing the client's views without imposing any of his or her values or viewpoints.

10. What is an important role of the nurse with regard to residents opposing plans to establish a group home or residential facility in their neighborhood? A) To provide information to correct misinformation related to stereotypes of persons with mental illnesses B) To persuade neighborhood residents that mentally ill people need safe, affordable, and desirable housing C) To provide for the safety and security of the neighborhood D) To ensure the security of persons in the group home

ANS A. To provide information to correct misinformation related to stereotypes of persons with mental illnesses Frequently, residents oppose plans to establish a group home or residential facility in their neighborhood. They argue that having a group home will decrease their property values, and they may believe that people with mental illness are violent, will act bizarrely in public, or will be a menace to their children. These people have strongly ingrained stereotypes and a great deal of misinformation. Local residents must be given the facts, and nurses are in a position to advocate for clients by educating members of the community. The neighborhood residents who object to the establishment of a group home or residential setting may not be motivated to understand the needs of mentally ill people. It is not the responsibility for the nurse to provide for the safety and security of the neighborhood or protect the safety and security of persons in the group home.

17. A nurse is assigned to care for a client whose sexual orientation differs from the nurse's sexual orientation. When should the nurse seek clinical supervision? A) When the nurse tries to assist the client to change values B) To discuss the nurse's feelings about the client with a supervisor C) When the nurse begins to empathize with the client D) When the nurse identifies anxieties regarding the client's values and sexuality

ANS A. When the nurse tries to assist the client to change values It is not the nurse's role to change the values of the client. The nurse should empathize with the client and be able to discuss feelings about the client with the nurse's supervisor, including anxieties regarding the client's values and sexuality.

10. Which of the following statements would be an empathetic response in a client interaction? A) ìYou must have been embarrassed when your father yelled at you in the grocery store.î B) ìYou really should find your own housing and get out of the situation with your father.î C) ìWell, it sounds like your father has difficulty controlling his temper.î D) ìWhy do you think your father chose that time and place to yell at you?î

ANS A. You must have been embarrassed when your father yelled at you in the grocery store. This statement conveys the nurse's understanding of the client's feelings. Empathy is the ability to place oneself into the experience of another for a moment in time. Nurses develop empathy by gathering as much information about an issue as possible directly from the client to avoid interjecting their personal experiences and interpretations of the situation. The other choices do not convey empathy.

5. A patient says, ìIts' been so long since I've been with my family.î Which statement by the nurse is an example of restating? A) ìYou say you haven't seen your family in a while.î B) ìTell me when you last saw your family.î C) ìGo on. Tell me more.î D) ìWhen was the last time you saw your family?î

ANS A. You say you haven't seen your family in a while.i Restating is repeating the main idea expressed. Restatement lets the client know that he or she communicated the idea effectively. This encourages the client to continue. Focusing or concentrating on a single point encourages the client to concentrate his or her energies on a specific point, which may prevent a multitude of factors or problems from overwhelming the client. General leads give encouragement to continue. They indicate that the nurse is listening and following what the client is saying without taking away the initiative for the interaction. Placing events in sequence clarifies the relationship of events in time. This helps both the nurse and the client to see them in perspective.

20. Which of the following are advantages of a crisis resolution team or home treatment team? Select all that apply. A) It is a residential treatment setting. B) It is more likely to help a client to perceive his or her situation more accurately. C) It is designed to assist clients in dealing with mental health crises without hospitalization. D) The client may feel better about asking for help. E) The client must meet multiple criteria to receive this type of care.

ANS B,C,D B) It is more likely to help a client to perceive his or her situation more accurately. C) It is designed to assist clients in dealing with mental health crises without hospitalization. D) The client may feel better about asking for help. Crisis resolution or respite care is a type of care for clients who have a perception of being in crisis and needing a more structured environment. A client having access to respite services is more likely to perceive his or her situation more accurately, feel better about asking for help, and avoid hospitalization.

31. Which of the following statements correctly depict the problem of feeling sympathy toward the client? Select all that apply. A) This can cause the nurse to feel sad and be unable to help the client. B) When the nurse's behavior is rooted in sympathy, the client finds it easier to manipulate the nurse's feelings. C) The client is discouraged from exploring his or her problems, thoughts, and feelings. D) The client is discouraged from growth. E) The client feels dependent on the nurse.

ANS B,C,D,E B) When the nurse's behavior is rooted in sympathy, the client finds it easier to manipulate the nurse's feelings. C) The client is discouraged from exploring his or her problems, thoughts, and feelings. D) The client is discouraged from growth. E) The client feels dependent on the nurse. The nurse who feels sorry for the client often tries to compensate by trying to please him or her. When the nurse's behavior is rooted in sympathy, the client finds it easier to manipulate the nurse's feelings. This discourages the client from exploring his or her problems, thoughts, and feelings; discourages client growth; and often leads to client dependency.

17. A patient has just been referred to a psychosocial rehabilitation program. The nurse explains that the benefits of being involved in such a program include: Select all that apply. A) continuous monitoring of symptoms. B) increased independence. C) increased involvement in treatment decisions. D) recovery from mental illness. E) increased community integration. F) greater opportunities for personal growth.

ANS B,D,E B) increased independence. D) recovery from mental illness. E) increased community integration. Goals of psychosocial rehabilitation programs include recovery from mental illness, personal growth, quality of life, community reintegration, empowerment, increased independence, decreased hospital admissions, improved social functioning, improved vocational functioning, continuous treatment, increased involvement in treatment decisions, improved physical health, and a recovered sense of self. Monitoring of symptoms and medication education are major foci of partial hospitalization programs

1. The nurse uses a variety of therapeutic communication skills when working with patients. Which of the following is a therapeutic goal that can be accomplished through the use of therapeutic communication skills? A) Inform the patient of priority problems B) Assess the patient's perception of a problem C) Assist the patient to control emotions D) Provide the patient with a plan of action

ANS B. Assess the patient's perception of a problem Therapeutic communication can help nurses to accomplish many goals including identifying the most important concern to the client at that moment, assessing the client's perception of the problem, facilitating the client's expression of emotions, and guiding the client toward identifying a plan of action.

30. A psychiatric nurse is planning an educational program addressing primary prevention strategies in the community. The nurse explores current research regarding which health-care need? A) Influencing schizophrenic patients to adhere to medication regimens B) Assisting high school students to effectively manage stress C) Coaching patients with depression to obtain employment D) Teaching parents the early signs of attention deficit disorder in children

ANS B. Assisting high school students to effectively manages stress Nurses work to provide mental health prevention services to reduce risks to the mental health of persons, families, and communities. Examples include primary prevention, such as stress management education; secondary prevention, such as early identification of potential mental health problems; and tertiary prevention, such as monitoring and coordinating rehabilitation services for the mentally ill.

21. The nurse and patient are visiting about upcoming sporting events of which they both share an interest. This form of interaction has the potential to threaten the nurseñpatient relationship by A) influencing whether the patient likes the nurse or not. B) avoiding serious work that can help the patient change. C) letting the patient know that the nurse is genuine with diverse interests. D) overstepping ethical boundaries that the nurse should maintain.

ANS B. Avoid serious work that can help the patient change Small talk or socializing is acceptable in nursing, but for the nurseñclient relationship to accomplish the goals that have been decided on, social interaction must be limited. If the relationship becomes more social than therapeutic, serious work that moves the client forward will not be done.

35. Which role of the nurse is most likely to create difficulty for the nurseñclient relationship if the client confuses physical care with intimacy and sexual interest? A) Teacher B) Caregiver C) Advocate D) Parent surrogate

ANS B. Caregiver Some clients may confuse physical care with intimacy and sexual interest, which can erode the therapeutic relationship. When the nurse is engaged in the role of teacher, the nurse may teach the client new methods of coping and solving problems or he or she may instruct the client about the medication regimen and available community resources. In the advocate role, the nurse informs the client and then supports him or her in whatever decision he or she makes. When a client exhibits child-like behavior or when a nurse is required to provide personal care such as feeding or bathing, the nurse may be tempted to assume the parental role.

6. The patient expresses frustration that the doctor does not spend enough time with the patient when making rounds. The nurse replies, ìThe doctors are very busy. What can I help you with?î The nurse incorporated which nontherapeutic technique in this response? A) Belittling B) Defending C) Disagreeing D) Introducing an unrelated topic

ANS B. Defending Defending attempts to protect someone or something from verbal attack. This implies that the client has no right to express impressions, opinions, or feelings. Belittling is misjudging the degree of the client's discomfort, which implies that the discomfort is temporary, mild, self-limiting, or not very important. Disagreeing is opposing the client's ideas, which may cause the client to feel defensive about his or her point of view or ideas. Introducing an unrelated topic is evidenced when the nurse changes the subject. This takes away the initiative for the client to interact.

13. The primary advantage of an evolving consumer household is that clients A) are provided with adequate income to combat poverty. B) do not have to relocate as they become more independent. C) have on-site staff supervision 24 hours a day. D) receive on-site medical care.

ANS B. Do not have to relocate as they become more independent An evolving consumer household is a permanent living situation, eliminating the need to change residential settings as clients gain independence. Many clients in evolving consumer households rely on Social Security Insurance or Social Security Disability Insurance. Clients function without onsite supervision.

29. During the working phase of a therapeutic relationship, which of the following actions by the nurse would best help the client to explore problems? A) Comparing past and present coping strategies B) Encouraging the client to clarify feelings and behaviors C) Identifying possible solutions for clients problems D) Referring the client to a self help group

ANS B. Encouraging the client to clarify feelings and behavior Helping the client to clarify feelings and behavior is a first step in problem identification and exploration. The nurse must remember that it is the client who examines and explores problem situations and relationships. The nurse must be nonjudgmental and refrain from giving advice. The other choices would not help the client to explore problems.

27. During a regular home health visit to an elderly client, the nurse observes that the client has feelings of hopelessness and despair. The client says, ìI'm old, and my life has no purpose anymore. But promise me you won't tell anyone.î How should the nurse respond? A) ìDon't worry, I won't tell anyone else.î B) ìI'm sorry, but I can't keep that kind of secret.î C) ìLet's talk about something to cheer you up.î D) ìWhat can we do to help you feel better?î

ANS B. I'm sorry, but i cant keep that kind of secret Keeping secrets with a client is not permissible, especially when the client's safety is concerned. The other choices would be inappropriate responses in this situation.

11. The nurse says to the client, ìYou become very anxious when we start talking about your drinking.î Which of the following techniques is the nurse using? A) Confronting behavior B) Making an observation C) Translating into feelings D) Verbalizing the implied

ANS B. Making an observation Feedback: The nurse is stating what he or she sees; the client can validate it or reject it. The nurse is not confronting the behavior in this situation. The nurse is not translating the message into feelings (seeking to verbalize client's feelings that he or she expresses only indirectly), nor is the nurse verbalizing the implied (voicing what the client has hinted at or suggested).

14. Which of the following statements about verbal and nonverbal communication skills is accurate? A) One third of meaning is transmitted nonverbally and two thirds is communicated verbally. B) Nonverbal communication is as important, if not more than, verbal communication. C) Verbal communication is most important because it is what the patient says. D) Verbal communication involves the unconscious mind.

ANS B. Nonverbal communication is as important, if not more than, verbal communication. Nonverbal communication is as important as, if not more so than, verbal communication. It is estimated that one third of meaning is transmitted by words and two thirds is communicated nonverbally. Verbal communication is often what the patient says but is not the most important. Nonverbal communication involves the unconscious mind acting out emotions related to the verbal content, the situation, the environment, and the relationship between the speaker and the listener.

18. A nurse notices a patient sitting quietly alone, eyes downcast, and looking sad. The nurse says to the patient, ìYou look like something is bothering you.î Which pattern of knowing did the nurse use to respond to the patient? A) Empirical knowing B) Personal knowing C) Ethical knowing D) Aesthetic knowing

ANS B. Personal knowing Personal knowing is obtained from life experience. An example would be a client's face shows the panic. Empirical knowing is obtained from the science of nursing. An example would be a client with panic disorder begins to have an attack. Panic attack will raise pulse rate. Ethical knowing is obtained from the moral knowledge of nursing. An example is although the nurse's shift has ended, she remains with the client. Aesthetic knowing is obtained from the art of nursing. Although the client shows outward signals now, the nurse has sensed previously the client's jumpiness and subtle differences in the client's demeanor and behavior.

1. The nurse is assessing the factors contributing to the well-being of a newly admitted client. Which of the following would the nurse identify as having a positive impact on the individual's mental health? A) Not needing others for companionship B) The ability to effectively manage stress C) A family history of mental illness D) Striving for total self-reliance

ANS B. The ability to effectively manage stress Individual factors influencing mental health include biologic makeup, autonomy, independence, self-esteem, capacity for growth, vitality, ability to find meaning in life, emotional resilience or hardiness, sense of belonging, reality orientation, and coping or stress management abilities. Interpersonal factors such as intimacy and a balance of separateness and connectedness are both needed for good mental health, and therefore a healthy person would need others for companionship. A family history of mental illness could relate to the biologic makeup of an individual, which may have a negative impact on an individual's mental health, as well as a negative impact on an individual's interpersonal and socialñcultural factors of health. Total self-reliance is not possible, and a positive social/cultural factor is access to adequate resources.

1.Which of the following factors is primarily responsible for the changes in inpatient hospital treatment between the 1980s and the present? A) Progress in treatment options for mentally ill persons B) The growth of managed care C) Less stigma associated with mental illness D) The current use of milieu therapy

ANS B. The growth of managed care Managed care exerts cost-control measures such as recertification of admissions, utilization review, and case managementóall of which have altered inpatient treatment significantly. There has been some progress in treatment options for mentally ill persons, but that is not the primary factor that has changed mental health inpatient hospital care. There is lesser stigma associated with mental illness, but that is not the primary factor that has changed mental health inpatient hospital care. In the 1980s, a typical psychiatric unit emphasized milieu therapy, which required long lengths of stay because clients with more stable conditions helped to provide structure and support for newly admitted clients with more acute conditions.

28. What would be the most appropriate action by the student nurse when the client asked the student nurse to keep it secret that the client plans to kill a family member? A) The student nurse must respect the client's privacy and not tell anyone. B) The student nurse must tell the client that the student nurse cannot keep that secret and then report it to the instructor and/or staff members. C) The student nurse must tell the client that the student nurse will keep the secret and then tell the instructor and/or staff members. D) The student nurse must tell the instructor and then ask the instructor to keep it secret.

ANS B. The student nurse must tell the client that the student nurse cannot keep that secret and then report it to the instructor and/or staff members. If a client tells a professional that the he or she has homicidal thoughts, the professional is released from privileged communication. The nurse is then required to notify intended victims and police of such a threat. The nurse must report the homicidal threat to the nursing supervisor and attending physician so that both the police and the intended victim can be notified.

33. The primary purpose for generalist nurses to develop skills with psychosocial interventions is A) psychosocial interventions are included on the nursing licensure examinations. B) psychosocial interventions are needed in all nursing practice settings. C) nurses will be consulted to assist in the care of psychiatric patients in acute care settings. D) there are a growing number of nursing practice opportunities in mental health settings.

ANS B. psychosocial interventions are needed in all nursing practice settings. Nurses often use psychosocial interventions to help meet clients' needs and achieve outcomes in all practice settings, not just mental health. Psychosocial interventions are included on the licensing exam, but that is not the primary reason for developing proficiency. Any health-care personnel will care for psychiatric patients in acute care settings. Current trends reflect a decline in mental health services and employment opportunities.

9. Which of the following are nontherapeutic techniques? Select all that apply. A) Silence B) Voicing doubt C) Agreeing D) Challenging E) Giving approval F) Accepting

ANS C,D,E C) Agreeing D) Challenging E) Giving approval Silence is a therapeutic technique that involves the absence of verbal communication, which provides time for the client to put thoughts or feelings into words, to regain composure, or to continue talking. Voicing doubt is a therapeutic technique that involves expressing uncertainty about the reality of the client's perceptions. Agreeing is a nontherapeutic technique that involves indicating accord with the client. Agreeing indicates the client is ìrightî rather than ìwrong,î and there is no opportunity for the client to change his or her mind without being ìwrong.î Challenging is a nonverbal communication technique that involves demanding proof from the client, and this may cause the client to defend delusions or misperceptions more strongly than before. Giving approval is a nontherapeutic communication technique that involves sanctioning the client's behavior or ideas. Accepting is a therapeutic technique that involves indicating reception.

35. Which approach to therapy is most effective when planning for a client with negative thinking? A) Behavior modification B) Client-centered therapy C) Cognitive therapy D) Reality therapy

ANS C. Cognitive therapy Cognitive therapy focuses on changing the client's thinking first, in the belief that then feelings and behavior can change as well. Behavior modification is a method of attempting to strengthen a desired behavior or response by reinforcement, either positive or negative. Client-centered therapy focuses on the role of the client, rather than the therapist, as the key to the healing process. Reality therapy focuses on the person's behavior and how that behavior keeps him or her from achieving life goals.

14. The primary goal of a psychiatric rehabilitation program is to promote A) return to prior level of functioning. B) medication compliance. C) complete recovery from mental illness. D) stabilization and management of symptoms.

ANS C. Complete recovery from mental illness Psychiatric rehabilitation goes beyond management of symptoms and medication management to include personal growth, reintegration into the community, empowerment, increased independence, and improved quality of life. It is not a goal of psychiatric rehabilitation to return to the prior level of functioning that may have been dysfunctional. It may not be realistic for the client to completely recover from mental illness, but rehabilitation can improve the quality of life for the client.

7. A patient asks the nurse what she should do about her ìcheatingî husband. The nurse replies, ìYou should divorce him. You deserve better than that.î The nurse used which communication technique? A) Giving information B) Verbalizing the implied C) Giving advice D) Agreeing

ANS C. Giving advice The nurse should not give advice, or tell the patient what to do. Advising implies that only the nurse knows what is best for the client. Giving information is therapeutic when the patient needs facts. Verbalizing the implied is a therapeutic communication technique which involves putting clearly into words what the patient has suggested. Verbalizing tends to make the discussion less obscure. Agreeing, or giving approval, indicates the patient is right or wrong. Nurses should remain neutral when using therapeutic communication skills.

26. A patient being discharged appears angry with the nurse when the nurse attempts to review discharge instructions with the patient. The nurse can best assist the patient in this stage of the relationship with which of the following responses? A) ìWe have to go over these instructions before you can go. Please try to listen.î B) ìWould you rather not be discharged today?î C) ìI can sense you are angry this morning. Tell me how you feel about being discharged today.î D) ìYou should be able to regulate your feelings better by now. Why are you angry

ANS C. I can sense you are angry this morning. Tell me how you feel about being discharged today. Both nurse and client usually have feelings about ending the relationship; the client especially may feel the termination as an impending loss. Often clients try to avoid termination by acting angry or as if the problem has not been resolved. The nurse can acknowledge the client's angry feelings and assure the client that this response is normal to ending a relationship. If the client tries to reopen and discuss old resolved issues, the nurse should identify the client's stalling maneuvers and refocus the client on newly learned behaviors and skills to handle the problem.

3. A patient who has continuously experienced severe symptoms of schizoaffective disorder for the past 17 years is experiencing an acute psychotic episode. Which level of care is most appropriate for this patient at this time? A) Partial hospitalization B) Residential treatment C) Inpatient hospital treatment D) Clubhouse

ANS C. Inpatient hospital treatment Long-stay clients in an inpatient setting are people with severe and persistent mental illness who continue to require acute care services despite the current emphasis on decreased hospital stays. This population includes clients who were hospitalized before deinstitutionalization and remain hospitalized despite efforts at community placement. It also includes clients who have been hospitalized consistently for long periods despite efforts to minimize their hospital stays. Partial hospitalization is designed for patients transitioning to independent living. Residential treatment and clubhouse model provide supervised independent living.

26. A patient has been started on antidepressants. The interdisciplinary team member most responsible for monitoring effectiveness and side effects of this new medication is the A) pharmacist. B) psychiatrist. C) psychiatric nurse. D) psychologist.

ANS C. Psychiatric nurse The nurse is also an essential team member in evaluating the effectiveness of medical treatment, particularly medications. The pharmacist has a working knowledge of medications but has limited contact with the patient. The primary function of the psychiatrist is diagnosis of mental disorders and prescription of medical treatments. The clinical psychologist practices therapy

5. Which of the following is the highest priority for admission to inpatient care? A) Confusion or disorientation B) Need for medication changes C) Safety of self or others D) Withdrawal from alcohol or other drugs

ANS C. Safety of self or others Safety is a priority; the inpatient setting provides for the safety of the client and/or others. Confusion or disorientation, need for medication changes, and withdrawal from alcohol or other drugs may also require inpatient care but the priority is safety.

12. The client says to the nurse, ìI feel really close to you. You are the only true friend I have.î The most therapeutic response the nurse can make is, A) ìI am sure there are other people in your life who are your friends; besides, we just met.î B) ìIt makes me feel good that you trust me so much; it is important for the work we are doing together.î C) ìSince ours is a professional relationship, let's explore other opportunities in your life for friendship.î D) ìWe are not friends. This is strictly professional.î

ANS C. Since ours is a professional relationship, let's explore other opportunities in your life for friendship. The nurse's response must let the client know in clear terms that the relationship is professional while not demeaning or ridiculing the client. The other choices would not be appropriate replies in this situation.

33. A nurse and patient have just completed reviewing the patient's take-home medications. The nurse is exemplifying which role during this intervention? A) Advocate B) Caregiver C) Teacher D) Parent Surrogate

ANS C. Teacher During the working phase of the nurseñclient relationship, the nurse may teach the client new methods of coping and solving problems. He or she may instruct about the medication regimen and available community resources. The caregiver role is used when the nurse helps the client meet psychosocial or physical needs. When functioning as an advocate, the nurse is acting on the client's behalf when he or she cannot do so. Nurses may need to assume a parental role when the patient needs nurturing or limit setting.

31. The nurse is working with a client who has a history of inflicting spousal abuse. Although the nurse does not condone domestic violence, the nurse treats the client with unconditional positive regard through which of the following? A) The nurse tries to understand the feelings that might have led to violent behavior. B) The nurse uses honest emotional expression in relating to client. C) The client is still viewed as someone worthy of respect and assistance. D) The nurse relates to the client as if he were her own spouse.

ANS C. The client is still viewed as someone worthy of respect and assistance Unconditional positive regard involves nonjudgmental caring for the client that is not dependent on the client's behavior. Genuineness is a realness or congruence between what the therapist feels and what he or she says to the client. Empathetic understanding is when the therapist senses the feelings and personal meaning from the client and communicates this understanding to the client.

16. A nurse is using the Johari window to identify the degree to which he feels comfortable communicating with others. After completing the exercise, the nurse discovers that quadrant 1 has the longest list of qualities. This indicates which of the following about the nurse? A) The nurse conceals personal information about himself. B) The nurse needs to increase insight into his own characteristics. C) The nurse is open to others. D) The patient is sharing more than the nurse in the therapeutic relationship.

ANS C. The nurse is open to others When using the Johari window, if quadrant 1 is the largest, this indicates that the nurse is open to others; a smaller quadrant 1 means that the nurse shares little about himself or herself with others. If quadrants 1 and 3 are both small, the person demonstrates little insight.

17. The nurse is sitting with a patient who is crying. After a few minutes the nurse places one hand on the patient's shoulder. Which of the following best describes the purpose of the nurse's touch with this patient? A) To express sympathy to the patient B) To assess the patient's skin temperature and circulation status C) To offer comfort and support for the patient D) To extend an offer of friendship to the patient

ANS C. To offer comfort and support for the patient Touching a client can be comforting and supportive when it is welcome and permitted. The nurse should not express sympathy to patients, nor should attempt to be ìfriendsî with patients. Physical assessment is not indicated at this time.

18. Which is a positive aspect of treating clients with mental illness in a community-based care? A) ìYou will not be allowed to go out with your friends while in the program.î B) ìYou will have to have supervision when you want to go anywhere else in the community.î C) ìYou will be able to live in your own home while you still see a therapist regularly.î D) ìYou will have someone in your home at all times to ask questions if you have any concerns.î

ANS C. You will be able to live in your own home while you still see a therapist Clients can remain in their communities, maintain contact with family and friends, and enjoy personal freedom that is not possible in an institution. Full-time home care is not included in community-based programs.

9. A patient is being transferred from a group home to an evolving consumer household. The goal of this transition is for the patient to eventually A) meet with a therapist on a weekly basis. B) resolve crises within a shorter time period. C) fulfill daily responsibilities without supervision. D) use the increased emotional support of paid staff.

ANS C. fulfill daily responsibilities without supervision. The evolving consumer household is a group-living situation in which the residents make the transition from a traditional group home to a residence where they fulfill their own responsibilities and function without onsite supervision from paid staff.

11. A nurse is working with a patient whose background is very different from hers. A good question to ask herself to assure she can be effective working with this patient would be, A) ìCan this person understand me?î B) ìDo I understand this patient's expectations of me?î C) ìWhat experiences do I have with people with similar backgrounds?î D) ìIs this person going to be able to relate to me?î

ANS C. ìWhat experiences do I have with people with similar backgrounds? To best assess self-awareness, the nurse should ask ìWhat experiences have I had with people from ethnic groups, socioeconomic classes, religions, age groups, or communities different from my own?î The nurse should not focus on the patient when examining self-awareness, rather, how the nurse's experiences have shaped attitudes and beliefs.

21. A nurse is meeting with the city council to advocate for mentally ill persons and the establishment of a group home in a neighborhood where the plans have been strongly opposed by the neighbors. The nurse can effectively educate the public on the realities of group home by citing research that indicates A) property values quickly rebound in neighborhoods that have group homes. B) police surveillance will be increased to avert any violence by residents. C) most people with mental illness do not represent a significant danger to others. D) neighborhoods that provide park areas provide children a centralized and safe place to play.

ANS C. most people with mental illness do not represent a significant danger to others. Frequently, residents oppose plans to establish a group home in their neighborhood, arguing that having a group home will decrease their property values, and they may believe that people with mental illness are violent, will act bizarrely in public, or will be a menace to their children. These people have strongly ingrained stereotypes and a great deal of misinformation.

8. A nurse makes the statement in a treatment team meeting, ìIt's not worth it to try to teach this patient how to make better choices. He has been here many times before and goes back home and does the same thing.î The nurse is sharing which of the following? A) Value B) Awareness C) Belief D) Attitude

ANS D. Attitude Attitudes are general feelings or a frame of reference around which a person organizes knowledge about the world and people. Values are abstract standards that give a person a sense of right and wrong and establish a code of conduct for living. Beliefs are ideas that one holds to be true; for example, ìAll old people are hard of hearing,î and ìIf the sun is shining, it will be a good day.î

10. When preparing for the first clinical experience with patients on a forensic unit at a psychiatric hospital, the nursing instructor discusses students' beliefs and fears surrounding forensic patients. The primary reason for discussing personal beliefs is to A) practice reflective communication skills in a role-play situation. B) assign the most compatible patients to the students. C) assess the appropriateness of the setting for implementing nursing skills. D) become aware of possible barriers to developing therapeutic relationships.

ANS D. Become aware of possible barriers to developing therapeutic relationships. Self-awareness allows the nurse to observe, pay attention to, and understand the subtle responses and reactions of clients when interacting with them. Nurses are responsible for caring for patients in all settings and build therapeutic relationship skills regardless of personal beliefs.

8. Which type of community residential treatment setting is most likely to be permanent in any state? A) Halfway house B) Respite housing C) Independent living programs D) Evolving consumer household

ANS D. Evolving consumer household Because the evolving consumer household is a permanent living arrangement, it eliminates the problem of relocation. Halfway houses usually serve as temporary placements that provide support as the clients prepare for independence. Clients who are served by respite housing are those who live in group homes or independently most of the time but have a need for ìrespiteî from their usual residences when the client experiences a crisis, feels overwhelmed, or cannot cope with problems or emotions. Independent living programs are available in many states, but may vary a great deal in regard to services provided with some agencies providing a broad range of services or shelter but few services.

32. A patient is being admitted to an inpatient unit for treatment of anorexia nervosa. Of the following assessment data, which should the nurse place as highest priority in the plan of care? A) Weight 24% below normal for height B) Distorted body image C) Feelings of inadequacy D) Frequent vomiting after meals

ANS D. Frequent vomiting after meals Maslow's hierarchy of needs hypothesizes that the basic needs at the bottom of the pyramid dominate the person's behavior until those needs were met, at which time the next level of needs would become dominant. Vomiting threatens fluid and electrolyte balance and poses a more acute threat to survival than low weight. Once basic physical needs are met, the higher level needs such as body image and self-esteem can be addressed.

30. Which of the following occurrences is considered a breach of professional boundaries? A) Patient asking a nurse for her phone number B) Refusing a gift from a patient C) Changing the subject in response to a patient complement D) Having a lengthy social conversation with a patient

ANS D. Having a lengthy social conversation with a patient The nurse must maintain professional boundaries to ensure the best therapeutic outcomes. The nurse must act warmly and empathetically but must not try to be friends with the client. Social interactions that continue beyond the first few minutes of a meeting contribute to the conversation staying on the surface. This lack of focus on the problems erodes the professional relationship. The nurse is responsible for maintaining boundaries in the event of patient inappropriateness.

34. An adolescent patient has just been found to have broken one of the unit rules. The nurse imposes the consequence of losing phone privileges. In this instance, the nurse is acting as A) advocate. B) caregiver. C) teacher. D) parent surrogate.

ANS D. Parent surrogate During the working phase of the nurseñclient relationship, nurses may need to assume a parental role when the patient needs nurturing or limit-setting. The nurse may also function as a teacher when the client needs to learn new skills, such as methods of coping and solving problems. The caregiver role is used when the nurse helps the client meet psychosocial or physical needs. When functioning as an advocate, the nurse is acting on the client's behalf when he or she cannot do so.

19. Which is the orientation of assertive community treatment (ACT)? A) Setting limits on mundane life issues B) Making a wide range of referrals C) Providing services in offices D) Problem-solving orientation

ANS D. Problem-solving orientation An ACT program has a problem-solving orientation: Staff members attend to specific life issues, no matter how mundane. ACT programs provide most services directly rather than relying on referrals to other programs or agencies, and they implement the services in the clients' homes or communities, not in offices.

12. Some residential treatment settings are transitional. This means that clients are eventually expected to A) become self-sufficient. B) find employment. C) no longer need medication. D) relocate to another setting.

ANS D. Relocate to another setting Transitional housing is temporary; clients are expected to move to another residential setting. Clients using transitional treatment settings are not expected to become totally self-sufficient, find employment, or not be in need of medication.

36. Which of the following statements is true about a nurse's self-disclosure? A) It is the basis for effective communication. B) Self-disclosure should be used with all clients to some degree. C) The more the nurse discloses, the more the client will disclose. D) Self-disclosure on the nurse's part should benefit the client.

ANS D. Self-disclosure on the nurse's part should benefit the client. Disclosing personal information to a client can be harmful and inappropriate, so it must be planned and considered thoughtfully in advance. The nurse should determine what benefit any given client will gain from nurse self-disclosure; only when that benefit can be clearly identified should self-disclosure be used, and then it should be used judiciously and within the boundaries of the relationship.

12. The nurse is sitting down with a patient to begin a conversation. Which of the following positions should the nurse take to convey acceptance of the patient? A) Leaning forward with arms on the table sitting directly across for the patient B) Turned slightly to the side of the patients with arms folded across the chest C) Leaning back in the chair next to the patient with legs crossed at the knees D) Sitting upright facing the patient with both feet on the floor

ANS D. Sitting upright facing the patient with both feet on the floor Closed body positions, such as crossed legs or arms folded across the chest, indicate that the interaction might threaten the listener who is defensive or not accepting. A better, more accepting body position is to sit facing the client with both feet on the floor, knees parallel, hands at the side of the body, and legs uncrossed or crossed only at the ankle.

6. The priority of inpatient care for people with severe mental illness is A) family issues. B) insight into illness. C) social skills. D) symptom management

ANS D. Symptoms management Rapid assessment, stabilization of symptoms, and discharge planning are the focus of inpatient care today. Family issues, insight into illness, and social skills would not be priorities of care for clients with severe mental illness.

4. A patient with depression is admitted to an inpatient hospital unit for treatment. The type of therapy most likely provided in this setting includes A) leisure skills. B) self-monitoring of treatment. C) skills for daily living. D) talk therapy.

ANS D. Talk therapy A typical psychiatric unit emphasizes talk therapy, or one-on-one interactions between residents and staff, and milieu therapy, meaning the total environment and its effect on the client's treatment. Partial hospitalization programs teach skills for daily living. Clubhouse models provide patients opportunities for leisure activities and self- monitoring of treatment.

9. The client tells the nurse, ìI don't think you can help me. Every time I talk to you, I am reminded of my mother, and I hated her.î The nurse should recognize this as A) confrontation. B) countertransference. C) incongruence. D) transference.

ANS D. Transference Transference occurs when the client unconsciously transfers to the nurse feelings he or she has for significant others. Confrontation is a technique used to highlight the incongruence between a person's verbalizations and actual behavior. Countertransference occurs when the therapist displaces onto the client attitudes or feelings from his or her past. Incongruence occurs when the communication content and process disagree.

15. The nurse must be alert to the nonverbal expressions of the client. Because the meaning attached to nonverbal behavior is subjective, it is important for the nurse to A) increase the client's awareness of nonverbal behavior. B) investigate the source of nonverbal behavior. C) validate the client's feelings. D) validate the meaning of the nonverbal behavior.

ANS D. Validate the meaning of nonverbal behavior It is essential to validate the meaning of nonverbal behavior (rather than assuming what it means) before proceeding with anything else. This item is about the nurse's understanding of nonverbal behavior, not the client's. Before the nurse can investigate the source of nonverbal behavior or validate the client's feelings the nurse must be clear about the meaning of the nonverbal behavior.

16. A nurse has invited a patient to sit down and have a conversation. The patient takes the first seat. The nurse pulls up another chair to sit with the patient. Approximately how far from the patient should the nurse place her chair? A) 1 to 2 feet B) 3 to 4 feet C) 6 to 8 feet D) 8 to 10 feet

ANS V. 3 to 4 feet The therapeutic communication interaction is most comfortable when the nurse and client are 3 to 6 feet apart; 0 to 18 inches is comfortable for parents with young children, people who mutually desire personal contact, or people whispering; 2 to 3 feet is comfortable between family and friends who are talking; 4 to 12 feet is acceptable for communication in social, work, and business settings.

2. Which of the following statements about mental illness are true? Select all that apply. A) Mental illness can cause significant distress, impaired functioning, or both. B ) Mental illness is only due to social/cultural factors. C) Social/cultural factors that relate to mental illness include excessive dependency on or withdrawal from relationships. D) Individuals suffering from mental illness are usually able to cope effectively with daily life. E) Individuals suffering from mental illness may experience dissatisfaction with relationships and self

ANS- A,D,E A) Mental illness can cause significant distress, impaired functioning, or both D) Individuals suffering from mental illness are usually able to cope effectively with daily life. E) Individuals suffering from mental illness may experience dissatisfaction with relationships and self Mental illness can cause significant distress, impaired functioning, or both. Mental illness may be related to individual, interpersonal, or social/cultural factors. Excessive dependency on or withdrawal from relationships are interpersonal factors that relate to mental illness. Individuals suffering from mental illness can feel overwhelmed with daily life. Individuals suffering from mental illness may experience dissatisfaction with relationships and self.

3. Which of the following are true regarding mental health and mental illness? A) Behavior that may be viewed as acceptable in one culture is always unacceptable in other cultures. B) It is easy to determine if a person is mentally healthy or mentally ill. C) In most cases, mental health is a state of emotional, psychological, and social wellness evidenced by satisfying interpersonal relationships, effective behavior and coping, positive self-concept, and emotional stability. D) Persons who engage in fantasies are mentally ill.

ANS- C In most cases, mental health is a state of emotional, psychological, and social wellness evidenced by satisfying interpersonal relationships, effective behavior Feedback: What one society may view as acceptable and appropriate behavior, another society may see that as maladaptive, and inappropriate. Mental health and mental illness are difficult to define precisely. In most cases, mental health is a state of emotional, psychological, and social wellness evidenced by satisfying interpersonal relationships, effective behavior and coping, positive self-concept, and emotional stability. Persons who engage in fantasies may be mentally healthy, but the inability to distinguish reality from fantasy is an individual factor that may contribute to mental illness.

16. A patient has just begun daily participation in a community-based partial hospitalization program. The patient can expect the staff to assist with which of the following treatment goals? Select all that apply. A) Stabilizing psychiatric symptoms B) Finding a better job C) Improving activities of daily living D) Learning to structure time E) Improved family support F) Developing social skills

ANS. A,C,D,F A) Stabilizing psychiatric symptoms C) Improving activities of daily living D) Learning to structure time F) Developing social skills Partial hospitalization programs are designed to help clients make a gradual transition from being inpatients to living independently and to prevent repeat admissions. In day treatment programs, clients return to home at night; evening programs are just the reverse. Partial hospitalization programs provide assistance with stabilizing psychiatric symptoms, monitoring drug effectiveness, stabilizing living environment, improving activities of daily living, learning to structure time, developing social skills, obtaining meaningful work, paid employment, or a volunteer position, and providing follow-up of any health concerns. Finding a better job and improving family support are not goals of partial hospitalization programs.

23. The nurse asks the patient, ìWhat was it like for you when you first knew you had no place to go?î The patient looks down and pauses for quite some time. Which action by the nurse is most therapeutic? A) Change the subject to something the patient will discuss B) Encourage the patient to express any unpleasant feelings C) Apologize for asking such a personal question D) Sit quietly until the patient responds

ANS. D Sit quietly until the patient responds Feedback: Silence or long pauses in communication may indicate many different things. The client may be depressed and struggling to find the energy to talk. Sometimes pauses indicate the client is thoughtfully considering the question before responding. At times, the client may seem to be ìlost in his or her own thoughtsî and not paying attention to the nurse. It is important to allow the client sufficient time to respond, even if it seems like a long time.

5. The nurse consults the DSM for which of the following purposes? A) To devise a plan of care for a newly admitted client B) To predict the client's prognosis of treatment outcomes C) To document the appropriate diagnostic code in the client's medical record D) To serve as a guide for client assessment

ANS. D. To serve as a guide for client assessment The DSM provides standard nomenclature, presents defining characteristics, and identifies underlying causes of mental disorders. It does not provide care plans or prognostic outcomes of treatment. Diagnosis of mental illness is not within the generalist RN's scope of practice, so documenting the code in the medical record would be inappropriate.

13. A patient states, ìI feel fine. It's a good day.î The nurse notes the patient looking away, and a decreasing pitch in his voice while speaking. Which of the following is the most therapeutic response by the nurse? A) ìI'm glad you are feeling good today.î B) ìI'm not sure I believe you.î C) ìTell me what is good about today.î D) ìYou say you feel fine, but you don't really sound fine.î

ANS. D. ìYou say you feel fine, but you don't really sound fine. This client's verbal and nonverbal communication seems incongruent. To ensure the accuracy of the patient's messages, the nurse identifies the nonverbal communication and checks its congruency with the content. An example is ìMr. Jones, you said everything is fine today, yet you frowned as you spoke. I sense that everything is not really fineî (verbalizing the implied). ìI'm glad you are feeling good today,î is agreeing or indicating accord with the client. Agreeing leaves no opportunity for the client to change his or her mind without being ìwrong.î ìI'm not sure I believe you could be interpreted as challenging or demanding proof from the client. Challenging causes the client to defend the misperceptions more strongly than before. ìTell me what is good about today,î seems to be asking the client to defend his or her statement.

21. A client diagnosed with a mild anxiety disorder has been referred to treatment in a community mental health center. Treatment most likely provided at the center includes A) medical management of symptoms. B) daily psychotherapy. C) constant staff supervision. D) psychological stabilization.

ANS: A medical management of symptoms Community mental health centers focus on rehabilitation, vocational needs, education, and socialization, as well as on management of symptoms and medication. Daily therapies, constant supervision, and stabilization require a more acute care inpatient setting.

11. The major problems with large state institutions are: Select all that apply. A) attendants were accused of abusing the residents. B) stigma associated with residence in an insane asylum. C) clients were geographically isolated from family and community. D) increasing financial costs to individual residents

ANS: A, C A) attendants were accused of abusing the residents. C) clients were geographically isolated from family and community. Clients were often far removed from the local community, family, and friends because state institutions were usually in rural or remote settings. Choices B and D were not major problems associated with large state instructions.

15. A basic assumption of Freud's psychoanalytic theory is that A) all human behavior can be caused and can be explained. B) human behavior is entirely unconscious. C) free association is the key to understanding. D) sexuality does not relate to behavior.

ANS: A. All human behavior can be caused and can be explained Freud believed that everything we do has meaning, whether it is conscious or unconscious. Freud believed that human behavior can be motivated by subconscious thoughts and feelings but could also be in the preconscious or unconscious. Freud based his theory of childhood development on the belief that sexual energy, termed libido, was the driving force of human behavior.

21. The nurse would recommend individual therapy for the patient who expresses a desire to A) bring about personal changes. B) gain a sense of belonging. C) develop leadership skills. D) learn more about treatment

ANS: A. Bring about personal changes People generally seek individual psychotherapy based on their desire to understand themselves and their behavior, to make personal changes, to improve interpersonal relationships, or to get relief from emotional pain or unhappiness. Groups are recommended for persons to accomplish tasks that require cooperation, collaboration, or working together.

7. A nurse is meeting with a crisis support group. In efforts to help patients identify with one another, the nurse explains which of the following about the crisis experience? A) ìEven happy events can cause a crisis if the stress is overwhelming.î B) ìOnly people who have unfortunate life events will experience a crisis.î C) ìA person has no control over how a crisis will affect him or her.î D) ìPeople can prevent all crises if they develop good coping skills early Ans: A

ANS: A. Even happy events cant cause a crisis if the stress is overwhelming Not all events that result in crisis are ìnegativeî in nature. Events like marriage, retirement, and childbirth are often desirable for the individual but may still present overwhelming challenges. All individuals can experience a crisis when they confront some life circumstance or stressor that they cannot effectively manage through use of their customary coping skills. A number of factors can influence how a person experiences a crisis.

24. Which of the following is most essential when planning care for a client who is experiencing a crisis? A) Explore previous coping strategies B) Explore underlying personality dynamics C) Focus on emotional deficits D) Offer a referral to a self-help group

ANS: A. Explore previous coping strategies Crisis intervention focuses on using the person's strengths, such as previous coping skills, and providing support to deal with the current situation. Exploring underlying personality dynamics and focusing on emotional deficits would not help the client in the crisis situation. When the client is in a crisis situation, offering a self-help group would not be appropriate.

23. A nurse is orienting to a new position working the infirmary in the state penitentiary. When working with prisoners who are also mentally ill, the nurse examines her own attitudes. Which of the following beliefs should the nurse discuss with her supervisor before caring for incarcerated patients? A) People with mental illness are inherently violent. B) The mentally ill can get better treatment in prison than in the community. C) People with mental illness are more vulnerable to victimization when incarcerated. D) Many mentally ill would not be in prison if they were stabilized on medication.

ANS: A. People with mental illness are inherently violent Although it is true that people with major mental illnesses who do not take prescribed medication are at increased risk for being violent, most people with mental illness do not represent a significant danger to others. Criminalization of mental illness refers to the practice of arresting and prosecuting mentally ill offenders, even for misdemeanors, at a rate four times that of the general population in an effort to contain them in some type of institution where they might receive needed treatment. People with a mental illness are more likely to be the victims of violence, both in prisons and in the community.

7. The legislation enacted in 1963 was largely responsible for which of the following shifts in care for the mentally ill? A) The widespread use of community-based services B) The advancement in pharmacotherapies C) Increased access to hospitalization D) Improved rights for clients in long-term institutional care

ANS: A. The widespread use of community based services The Community Mental Health Centers Construction Act of 1963 accomplished the release of individuals from long-term stays in state institutions, the decrease in admissions to hospitals, and the development of community-based services as an alternative to hospital care.

5. A patient reports a pattern of being suspicious and mistrusting of others, causing difficulty in sustaining lasting relationships. Which stage according to Erikson's psychosocial development was not successfully completed? A) Trust B) Autonomy C) Initiative D) Industry

ANS: A. Trust The formation of trust is essential: mistrust, the negative outcome of this stage, will impair the person's development throughout his or her life.

30. A nurse is assisting a patient who is working on the technique of systematic desensitization. When the patient feels anxious, the nurse can best use the principles of this technique by stating, A) ìUse the deep breathing techniques we practiced yesterday.î B) ìWhat is the worst that will happen if you confront this fear?î C) ìTell me how you are feeling right now.î D) ìI can see you are anxious. Let's stop for a minute.î

ANS: A. Use the deep breathing techniques we practices yesterday Systematic desensitization can be used to help clients overcome irrational fears and anxiety associated with phobias. The client learns and practices relaxation techniques to decrease and manage anxiety. He or she is then exposed to the least anxiety provoking situation and uses the relaxation techniques to manage the resulting anxiety. Confronting irrational thoughts is part of rational emotive therapy. Encouraging expression of feelings is associated with gestalt therapy.

9. Which of the following are examples of adventitious crises? Select all that apply. A) Death of a loved one B) Natural disasters C) Violent crimes D) War E) Leaving home for the first time

ANS: B,C,D B) Natural disasters C) Violent crimes D) War Adventitious crises include natural disasters like floods, earthquakes, or hurricanes; war, terrorist attacks; riots; and violent crimes such as rape or murder. Maturational or developmental crises are predictable events in the normal course of life, such as leaving home for the first time, getting married, having a baby, and beginning a career. Situational crises are unanticipated or sudden events that threaten the individual's integrity, such as the death of a loved one, loss of a job, and physical or emotional illness in the individual or family member.

4. Which of the following behaviors by the nurse demonstrate positive regard? Select all that apply. A) Communicating judgments about the client's behavior B) Calling the client by name C) Spending time with the client D) Responding openly E) Considering the client's ideas and preference when planning care

ANS: B,C,D,E Calling the client by name, spending time with the client, and listening and responding openly are measures by which the nurse conveys respect and positive regard to the client. The nurse also conveys positive regard by considering the client's ideas and preferences when planning care. The nurse maintains attention on the client and avoids communicating negative opinions or value judgments about the client's behavior.

22. The nurse is mindful of maintaining relationships with patients that are therapeutic. Certain characteristics of the relationships the nurse will foster include: Select all that apply. A) offering sound advice to the patient. B) establishing boundaries for both the nurse and patient. C) maintaining a patient-focus at all times. D) sharing personal feelings openly with the patient. E) avoiding concern with whether the patient likes the nurse.

ANS: B,C,E B) establishing boundaries for both the nurse and patient. C) maintaining a patient-focus at all times. E) avoiding concern with whether the patient likes the nurse. The therapeutic relationship focuses on the needs, experiences, feelings, and ideas of the client only. In the therapeutic relationship, the parameters are clear: the focus is the client's needs, not the nurse's. The nurse should not be concerned about whether or not the client likes him or her or is grateful. A social relationship is focuses on sharing ideas, feelings, and experiences and meets the basic need for people to interact. In social relationships, advice is often given. This should be avoided in therapeutic relationships.

8. Which of the following theories could be classified as humanistic theories? Select all that apply. A) Cognitive therapy B) Maslow's hierarchy of needs C) Gestalt therapy D) Rogers' client-centered therapy E) Rational emotive therapy F) Piaget's cognitive stages of development

ANS: B,D B) Maslow's hierarchy of needs D) Rogers' client centered therapy Humanism represents a significant shift away from the psychoanalytic view of the individual as a neurotic, impulse-driven person with repressed psychic problems and away from the focus on and examination of the client's past experiences. Humanistic theories include Maslow's hierarchy of needs and Rogers' client-centered therapy. Cognitive therapy is an existential therapy that focuses on immediate thought processingóhow a person perceives or interprets his or her experience and determines how he or she feels and behaves. Gestalt therapy is an existential therapy that emphasizes the person's feelings and thoughts in the here and now. Rational emotive therapy is an existential theory that looks at irrational beliefs and automatic thoughts that make people unhappy. Piaget's cognitive stages of development is a developmental theory.

28. A student appears very nervous on the first day of clinical in a psychiatric setting. The student reviews the instructor's guidelines and appropriately takes which of the following actions? Select all that apply. A) Tells the client about personal events and interests B) Discusses the anxious feelings with the instructor C) Assumes that the client's unwillingness to talk to a student nurse is a personal insult or failure D) Builds rapport with the patient before asking personal questions E) Consults the instructor if a shocking situation arises F) Gravitates to clients that the student may know personally

ANS: B,D,E B) Discusses the anxious feelings with the instructor D) Builds rapport with the patient before asking personal questions E) Consults the instructor if a shocking situation arises Listening carefully, showing genuine interest, and caring about the client are extremely important rather than speaking about oneself. The student must deal with his or her own anxiety about approaching a stranger to talk about very sensitive and personal issues. Student nurses should not see the client's unwillingness to talk to a student nurse as a personal insult or behavior. Being available and willing to listen are often all it takes to begin a significant interaction with someone. Questions involving personal matters should not be the first thing a student says to the client. These issues usually arise after some trust and rapport have been established. The nursing instructor and staff are always available to assist if the client is shocking or distressing to the student. If the student recognizes someone he or she knows, it is usually best for the student to talk with the client and reassure him or her about confidentiality. The client should be reassured that the student will not read the client's record and will not be assigned to work with the client.

2. A patient who has been working on controlling impulsive behavior shows a strengthening ego through which of the following behaviors? A) Going to therapy only when there is nothing more desirable to do B) Weighing the advantages and disadvantages before making a decision C) Telling others in the group the right way to act D) Reporting having fun at a recent social event

ANS: B. B) Weighing the advantages and disadvantages before making a decision The id is the part of one's nature that reflects basic or innate desires such as pleasure- seeking behavior, aggression, and sexual impulses. The id seeks instant gratification, causes impulsive unthinking behavior, and has no regard for rules or social convention. The superego is the part of a person's nature that reflects moral and ethical concepts, values, and parental and social expectations; therefore, it is in direct opposition to the id. The third component, the ego, is the balancing or mediating force between the id and the superego. The ego represents mature and adaptive behavior that allows a person to function successfully in the world.

28. A nurse is working with a patient with an eating disorder who refuses to eat a muffin. The nurse asks the patient ìIs there any way that you could see the muffin as just flour and water, basic nutrients your body needs?î In this statement, the nurse is using which type of therapy? A) Rational emotive therapy B) Cognitive therapy C) Gestalt therapy D) Reality therapy

ANS: B. Cognitive therapy Cognitive therapy focuses on immediate thought processing, or how a person perceives or interprets his or her experience and determines how he or she behaves. Rational emotive therapy considers not only thoughts but feelings associated with thoughts. Gestalt therapy focuses on the person's thoughts and feelings in the here and now. Reality therapy challenges people to examine how behavior interferes with life goals.

9. The goal of the 1963 Community Mental Health Centers Act was to A) ensure patients' rights for the mentally ill. B) deinstitutionalize state hospitals. C) provide funds to build hospitals with psychiatric units. D) treat people with mental illness in a humane fashion.

ANS: B. Deinstitutionalize state hospitals The 1963 Community Mental Health Centers Act intimated the movement toward treating those with mental illness in a less restrictive environment. This legislation resulted in the shift of clients with mental illness from large state institutions to care based in the community. Answer choices A, C, and D were not purposes of the 1963 Community Mental Health Centers Act.

26. Which of the following is a standard of professional performance? A) Assessment B) Education C) Planning D) Implementation

ANS: B. Education Education is a standard of professional performance. Other standards of professional performance include the quality of practice, professional practice evaluation, collegiality, collaboration, ethics, research, resource utilization, and leadership. Assessment, planning, and implementation are components of the nursing process, not standards of professional performance.

6. Which of the following is the most important skill the nurse must bring to the therapeutic nurseñclient relationship? A) Confrontation B) Empathy C) Humor D) Reframing

ANS: B. Empathy The nurse must be able to express caring and concern for the client. Empathy is the ability of the nurse to perceive the meanings and feelings of the client and to communicate that understanding to the client. The ability to use confrontation, humor and reframing are also important skills but not as important as the skill of empathy.

19. The family members of a patient with bipolar disorder express frustration with the unpredictable behaviors of their loved one. Which group should the nurse suggest as most helpful to this family? A) Family therapy group B) Family education group C) Psychotherapy group D) Self-help support group

ANS: B. Family education group Family education discusses the clinical treatment of mental illnesses and teaches the knowledge and skills that family members need to cope more effectively. The goals of family therapy groups include understanding how family dynamics contribute to the client's psychopathology, mobilizing the family's inherent strengths and functional resources, restructuring maladaptive family behavioral styles, and strengthening family problem-solving behaviors. The goal of a psychotherapy group is for members to learn about their behavior and to make positive changes in their behavior by interacting and communicating with others. In a self-help group, members share a common experience, but the group is not a formal or structured therapy group.

6. The nurse has established a therapeutic relationship with a patient. The patient is beginning to share feelings openly with the nurse. The relationship has entered which phase according to Peplau's theory? A) Orientation B) Identification C) Exploitation D) Resolution

ANS: B. Identification The orientation phase is directed by the nurse and involves engaging the client in treatment, providing explanations and information, and answering questions. The identification phase begins when the client works interdependently with the nurse, expresses feelings, and begins to feel stronger. In the exploitation phase, the client makes full use of the services offered. In the resolution phase, the client no longer needs professional services and gives up dependent behavior and the relationship ends.

14. A client begins to take stock of his life and look into the future. The nurse assesses that this client is in which of Erikson's developmental stages? A) Identity versus role confusion B) Industry versus inferiority C) Integrity versus despair D) Generativity versus stagnation

ANS: B. Industry versus inferiority Erikson's stage of integrity versus despair is when an adult begins to reflect on his or her life. Identity versus role confusion occurs in adolescence when the person is forming a sense of self and belonging. Integrity versus despair occurs in maturity; accepting responsibility for oneself and life is the corresponding task. Generativity versus stagnation occurs in middle adulthood, which includes the tasks of being creative and productive and establishing the next generation.

3. Which of the following statements is true of the component of a therapeutic relationshipóìacceptanceî? A) The nurse accepts the behavior of any inappropriate behavior. B) It is avoiding judgments of the person, no matter what the behavior is. C) It involves punishment for inappropriate behavior. D) It is the ability of the nurse to perceive the meanings and feelings of the client and to communicate that understanding to the client.

ANS: B. It is avoiding judgments of the person, no matter what the behavior is Acceptance is avoiding judgments of the person, no matter what the behavior is. It means accepting the person but not necessarily the behavior. It does not involve punishment for inappropriate behavior. Empathy is the ability of the nurse to perceive the meanings and feelings of the client and to communicate that understanding to the client.

8. Which one of the following is a result of federal legislation? A) Making it easier to commit people for mental health treatment against their will. B) Making it more difficult to commit people for mental health treatment against their will. C) State mental institutions being the primary source of care for mentally ill persons. D) Improved care for mentally ill persons.

ANS: B. Making it more difficult to commit people for mental health treatment against their will Commitment laws changed in the early 1970s, making it more difficult to commit people for mental health treatment against their will. Deinstitutionalization accomplished the release of individuals from long-term stays in state institutions. Deinstitutionalization also had negative effects in that some mentally ill persons are subjected to the revolving door effect, which may limit care for mentally ill persons.

23. Which one of the following is an important characteristic of an effective therapistñclient relationship in individual psychotherapy? A) Homogeneity between the client and the therapist. B) Mutual benefit for the client and the therapist. C) The client must adapt to the therapist's style of therapy and theoretical beliefs. D) Match between the theoretical beliefs and style of therapy and the client's needs and expectations of therapy

ANS: B. Mutual benefit for the client and the therapist ompatibility between the therapist and the client is required for therapy to be effective. The client must select a therapist whose theoretical beliefs and style of therapy are congruent with the client's needs and expectations of therapy. It is not required that the client and therapist be the same. The client's benefit is the most important consideration. The client also may have to try different therapists to find a good match.

27. Which of the following is a standard of practice? A) Quality of care B) Outcome identification C) Collegiality D) Performance appraisal

ANS: B. Outcome identification Standards of practice include assessment, diagnosis, outcomes identification, planning, implementation, coordination of care, health teaching and health promotion, and milieu therapy. The standards of professional performance include quality of practice, education, professional practice evaluation, collegiality, collaboration, ethics, research, resource utilization, and leadership.

17. Which cognitive mode, according to Harry Stack Sullivan, begins in early childhood as the child begins to connect experiences in sequence? A) Prototaxic mode B) Parataxic mode C) Bitaxic mode D) Syntaxic mode

ANS: B. Parataxic mode The parataxic mode begins in early childhood as the child begins to connect experiences in sequence. The child may not make logical sense of the experiences, although he or she may not understand what he or she is doing. The prototaxic mode involves brief, unconnected experiences that have no relationship to one another. In the syntaxic mode, the person begins to perceive himself or herself and the world within the context of the environment and can analyze experiences in a variety of settings. There is not a bitaxic mode.

13. A client is supposed to be ambulating ad lib. Instead, he refuses to get out of bed, asks for a bed bath, and makes many demands of the nurses. He also yells that they are lazy and incompetent. The client's behavior is an example of which of the following defense mechanisms? A) Introjection B) Projection C) Rationalization D) Reaction formation

ANS: B. Projection Projection is blaming unacceptable thoughts on others; the client cannot accept the fact that he may be lazy or incompetent to care for himself. Introjection is accepting another person's attitudes, beliefs, and values as one's own. Rationalization is excusing one's own behavior to avoid guilt, responsibility, conflict, anxiety, or loss of self-concept. Reaction formation is acting the opposite of what one thinks or feels.

12. A college student decides to go to a party the night before a major exam instead of studying. After receiving a low score on the exam, the student tells a fellow student, ìI have to work too much and don't have time to study. It wouldn't matter anyway because the teacher is so unreasonable.î The defense mechanisms the student is using are A) denial and displacement B) rationalization and projection C) reaction formation and resistance D) regression and compensation

ANS: B. Rationalization and projection When stating that it wouldn't matter if the student studied, the student is using rationalization, which is excusing own behavior to avoid guilt, responsibility, conflict, anxiety, or loss of self-respect. When stating that the teacher is unreasonable, the student is using projection or the unconscious blaming of unacceptable inclinations or thoughts as an external object. Denial is the failure to acknowledge an unbearable condition. Displacement is the ventilation of intense feelings toward persons less threatening than the one who aroused those feelings. Reaction formation is acting the opposite of what one thinks or feels. Resistance is overt or covert antagonism toward remembering or processing anxiety-producing information. Regression is moving back to a previous developmental stage to feel safe or have needs met. Compensation is overachievement in one area to offset real or perceived deficiencies in another area.

27. A patient is encouraged to join in daily outdoor games with peers on the unit. The interdisciplinary team member who will monitor the patient's involvement will be the A) occupational therapist. B) recreation therapist. C) vocational rehabilitation therapist. D) psychiatric nurse.

ANS: B. Recreation therapist The recreation therapist helps the client to achieve a balance of work and play in his or her life and provides activities that promote constructive use of leisure or unstructured time. Occupational therapy focuses on the functional abilities of the client and ways to improve client functioning. Vocational rehabilitation includes determining clients' interests and abilities and matching them with vocational choices. The nurse has a solid foundation in health promotion, illness prevention, and rehabilitation in all areas, allowing him or her to view the client holistically. The nurse is also an essential team member in evaluating the effectiveness of medical treatment, particularly medications.

29. The appropriate action for a student nurse who says the wrong thing is to A) pretend that the student nurse did not say it. B) restate it by saying, ìThat didn't come out right. What I meant was...î C) state that it was a joke. D) ignore the error, since no one is perfect.

ANS: B. Restate it by saying, that didnt come out right what i meant was No one magic phrase can solve a client's problems; likewise, no single statement can significantly worsen them. Listening carefully, showing genuine interest, and caring about the client are extremely important. A nurse who possesses these elements but says something that sounds out of place can simply restate it by saying, ìThat didn't come out right. What I meant wasÖî Pretending that the student nurse did not say it, stating that it was a joke, and ignoring the error are not likely to help the student nurse build and maintain credibility with the client.

15. What is meant by the term revolving door effect in mental health care? A) An overall reduction in incidence of severe mental illness B) Shorter and more frequent hospital stays for persons with severe and persistent mental illness C) Flexible treatment settings for mentally ill D) Most effective and least expensive treatment settings

ANS: B. Shorter and more frequent hospital stays for persons with severe and persistent mental illness The revolving door effect refers to shorter, but more frequent, hospital stays. Clients are quickly discharged into the community where services are not adequate; without adequate community services, clients become acutely ill and require rehospitalization. The revolving door effect does not refer to flexible treatment settings for mentally ill. Even though hospitalization is more expensive than outpatient treatment, if utilized appropriately could result in stabilization and less need for emergency department visits and/or rehospitalization. The revolving door effect does not relate to the incidence of severe mental illness.

24. A new graduate nurse has accepted a staff position at an inpatient mental health facility. The graduate nurse can expect to be responsible for basic-level functions, including A) providing clinical supervision. B) using effective communication skills. C) adjusting client medications. D) directing program development

ANS: B. Using effective communication skills Basic-level functions include counseling, milieu therapy, self-care activities, psychobiologic interventions, health teaching, case management, and health promotion and maintenance. Advanced-level functions include psychotherapy, prescriptive authority for drugs, consultation and liaison, evaluation, program development and management, and clinical supervision.

1. The nurse understands that empathy is essential to the therapeutic relationship. When a patient makes the statement, ìI am just devastated that my marriage is falling apart,î the nurse can best show empathy through which of the following responses? A) ìI feel so bad for what you are going through.î B) ìYou feel like your world is falling apart right now.î C) ìI have been divorced too. I know how hard it is.î D) ìIt will get better; let's talk about it.î

ANS: B. You feel like your world is falling apart right now Therapeutic communication techniques, such as reflection, restatement, and clarification, help the nurse to send empathetic messages to the client. The nurse must understand the difference between empathy and sympathy (feelings of concern or compassion one shows for another). Sympathy often shifts the emphasis to the nurse's feelings, hindering the nurse's ability to view the client's needs objectively.

19. One of the unforeseen effects of the movement toward community mental health services is A) fewer clients suffering from persistent mental illnesses. B) an increased number of hospital beds available for clients seeking treatment. C) an increased number of admissions to available hospital services. D) Longer hospital stays for people needing mental health services.

ANS: C an increased number of admissions to available hospital services Although people with severe and persistent mental illness have shorter hospital stays, they are admitted to hospitals more frequently. Although deinstitutionalization reduced the number of public hospital beds by 80%, the number of admissions to those beds correspondingly increased by 90%. The number of individuals with mental illness did not change.

23. Psychiatric nursing became a requirement in nursing education in which year? A) 1930 B) 1940 C) 1950 D) 1960

ANS: C. 1950 It was not until 1950 that the National League for Nursing, which accredits nursing programs, required schools to include an experience in psychiatric nursing.

22. Which of the following is defined as an advanced-level function in the practice area of psychiatric mental health nursing? A) Case management B) Counseling C) Evaluation D) Health teaching

ANS: C. Evaluation Advanced-level functions are psychotherapy, prescriptive authority, consultation and liaison, evaluation, and program development and management. Case management, counseling, and health teaching are basic-level functions in the practice area of psychiatric mental health nursing.

11. The nurse is assessing a client who is talking about her son's recent death but who shows no emotion of any kind. The nurse recognizes this behavior as which of the following defense mechanisms? A) Dissociation B) Displacement C) Intellectualization D) Suppression

ANS: C. Intellectualization The client is aware of the facts of the situation but does not show the emotions associated with the situation. Dissociation involves dealing with emotional conflict by a temporary alteration in consciousness or identity. Displacement is the ventilation of intense feelings toward a person less threatening than the one who aroused those feelings. Suppression is replacing the desired gratification with one that is more readily available.

Which of the following statements is true of treatment of people with mental illness in the United States today? A) Substance abuse is effectively treated with brief hospitalization. B) Financial resources are reallocated from state hospitals to community programs and support. C) Only 25% of people needing mental health services are receiving those services. D) Emergency department visits by persons who are acutely disturbed are declining.

ANS: C. Only 25% of people needing mental health services are receiving those services Only one in four (25%) adults needing mental health care receives the needed services. Substance abuse issues cannot be dealt with in the 3 to 5 days typical for admissions in the current managed care environment. Money saved by states when state hospitals were closed has not been transferred to community programs and support. Although people with severe and persistent mental illness have shorter hospital stays, they are admitted to hospitals more frequently. In some cities, emergency department visits for acutely disturbed persons have increased by 400% to 500%.

16. Which of the following is a major developmental task of middle adulthood? A) Developing intimacy B) Learning to manage conflict C) Reexamining life goals D) Resolving the past

ANS: C. Reexamining life goals An important task for middle-aged adults is to examine life goals, ideally with some satisfaction. Developing intimacy occurs in young adulthood. Learning to manage conflict occurs in preschool. Resolving the past and accepting responsibility for oneself and life occur in maturity.

25. Which one of the following is one of the American Nurses Association standards of practice for psychiatricñmental health nursing? A) Prescriptive authority is granted to psychiatricñmental health registered nurses. B) All aspects of Standard 5: Implementation may be carried out by psychiatricñmental health registered nurses. C) Some aspects of Standard 5: Implementation may only be carried out by psychiatricñmental health advanced practice nurses. D) Psychiatricñmental health advanced practice nurses are the only ones who may provide milieu therapy.

ANS: C. Some aspects of standard 5: implementation may only be carried out by psychiatricñmental health advanced practice nurses Prescriptive authority is used by psychiatricñmental health advanced practice registered nurses in accordance with state and federal laws and regulations. Standards 5DñG are advanced practice interventions and may be performed only by the psychiatricñmental health advanced practice registered nurse. Psychiatricñmental health registered nurses may provide milieu therapy according to Standard 5C. This is not restricted to psychiatricñmental health advanced practice nurses.

29. A nurse documents that a patient has successfully acquired a job performing janitorial services at a local manufacturing company. The goal of which of the following levels of prevention has been achieved? A) Primary prevention B) Secondary prevention C) Tertiary prevention D) Community prevention

ANS: C. Tertiary prevention Nurses work to provide mental health prevention services to reduce risks to the mental health of persons, families, and communities. Examples include primary prevention, such as stress management education; secondary prevention, such as early identification of potential mental health problems; and tertiary prevention, such as monitoring and coordinating rehabilitation services for the mentally ill.

1. The nurse understands that crises are self-limiting. This implies that upon evaluation of crisis intervention, the nurse should assess for which outcome? A) The patient will identify possible causes for the crisis. B) The patient will discover a new sense of self-sufficiency in coping. C) The patient will resume the precrisis level of functioning. D) The patient will express anger regarding the crisis event.

ANS: C. The patient will resume the pre crisis level of functioning Crises usually exist for 4 to 6 weeks. At the end of that time, the crisis is resolved in one of three ways. In the first two, the person either returns to his or her precrisis level of functioning or begins to function at a higher level; both are positive outcomes for the individual. The third resolution is that the person's functioning stabilizes at a level lower than precrisis functioning, which is a negative outcome for the individual. Assisting the person to use existing supports or helping the individual find new sources of support can decrease the feelings of being alone or overwhelmed. The patient may develop guilt if he or she examines possible causes for the crisis. Expression of anger at 4 to 6 weeks indicates a less than favorable outcome of crisis intervention.

7. Which is a standard for establishing a code of conduct for living? A) Acceptance B) Empathy C) Values D) Positive regard

ANS: C. Values Values are abstract standards that give a person a sense of right and wrong and establish a code of conduct for living. Acceptance occurs when the nurse does not become upset or respond negatively to a client's outbursts, anger, or acting out. Empathy is the ability of the nurse to perceive the meaning and feelings of the client and to communicate that understanding to the client. Positive regard is an unconditional, nonjudgmental attitude.

4. A teenage patient defies the nurse's repeated requests to turn off the video game and go to sleep. The teen says angrily, ìYou sound just like my mother at home!î and continues to play the video game. The nurse understands that this statement likely indicates A) the need of stricter discipline at home. B) early signs of oppositional defiant disorder. C) viewing the nurse as her mother. D) expression of developing autonomy.

ANS: C. Viewing the nurse as her mother Transference occurs when the client displaces onto the therapist attitudes and feelings that the client originally experienced in other relationships. Transference patterns are automatic and unconscious in the therapeutic relationship. The occurrence of transference does not indicate ineffective parenting or disciplinary practices, nor is it indicative of a disorder. Autonomy is developed much earlier in the toddler years.

18. Group members are actively discussing a common topic. Members are sharing that they identify with what others are saying. The nurse leader recognizes that the group is in which stage of group development? A) Planning B) Initial C) Working D) Termination

ANS: C. Working The working stage of group development begins as members begin to focus their attention on the purpose or task the group is trying to accomplish. The beginning stage of group development, or the initial stage, commences as soon as the group begins to meet. Members introduce themselves, a leader can be selected, the group purpose is discussed, and rules and expectations for group participation are reviewed. The final stage, or termination, of the group occurs before the group disbands. The work of the group is reviewed, with the focus on group accomplishments or growth of group members.

20. A student nurse attends a self-help group as part of a class assignment. While there the student recognizes a family friend. Upon returning home, the student talks about the experience with the family. The student's actions can be described as A) appropriate; persons familiar with group members are allowed self-help group membership. B) appropriate; self-help groups are not professional and therefore are open to public knowledge. C) inappropriate; most self-help groups have a rule of confidentiality. D) inappropriate; the student should not have been allowed to attend the group.

ANS: C. inappropriate; most self-help groups have a rule of confidentiality. Most self-help groups have a rule of confidentiality: whoever is seen and whatever is said at the meetings cannot be divulged to others or discussed outside the group. In many 12-step programs, such as Alcoholics Anonymous and Gamblers Anonymous, people use only their first names, so their identities are not divulged (although in some settings, group members do know one another's names).

6. Which would be a reason for a student nurse to use the DSM? A) Identifying the medical diagnosis B) Treat clients C) Evaluate treatments D) Understand the reason for the admission and the nature of psychiatric illnesses.

ANS: D Understand the reason for the admission and the nature of psychiatric illnesses. Although student nurses do not use the DSM to diagnose clients, they will find it a helpful resource to understand the reason for the admission and to begin building knowledge about the nature of psychiatric illnesses. Identifying the medical diagnosis, treating, and evaluating treatments are not a part of the nursing process.

12. A significant change in the treatment of people with mental illness occurred in the 1950s when A) community support services were established. B) legislation dramatically changed civil commitment procedures. C) the Patient's Bill of Rights was enacted. D) psychotropic drugs became available for use.

ANS: D psychotropic drugs became available for use The development of psychotropic drugs, or drugs used to treat mental illness, began in the 1950s. Answer choices A, B, and C did not occur in the 1950s.

31. A psychiatric nurse is planning activities aimed at secondary prevention of mental illness. Which activity would be most appropriate to develop? A) Self-esteem building with a local after-school program B) Social skills training for chronic schizophrenics C) Parenthood classes at a local community center D) Depression screening in an assisted living facility

ANS: D) Depression screening in an assisted living facility Nurses work to provide mental health prevention services to reduce risks to the mental health of persons, families, and communities. Examples include primary prevention, such as stress management education; secondary prevention, such as early identification of potential mental health problems; and tertiary prevention, such as monitoring and coordinating rehabilitation services for the mentally ill.

24. The nurse is part of a group setting up a mobile crisis service in conjunction with the local police department. Community education on which of the following this team will focus includes? A) Teaching police officers counseling skills B) Crisis counseling services to be provided in the prison system C) Educating about the dangers of the mentally ill in the community D) Assisting police officers to recognize mental illness

ANS: D. Assisting police officers to recognize mental illness Mobile crisis services are linked to police departments. These professionals are called to the scene when police officers believe mental health issues are involved. Frequently, the mentally ill individual can be diverted to crisis counseling services or to the hospital, if needed, instead of being arrested and going to jail. Often, these same professionals provide education to police to help them recognize mental illness and perhaps change their attitude about mentally ill offenders. They do not provide direct counseling training to police officers.

22. Which one of the following statements is most accurate regarding the cohesiveness of a group in group therapy? A) It is commonly present in the first meeting of the group. B) It is necessary for the group to have maximum cohesiveness, the more the better. C) Group cohesiveness is the degree to which members think alike and many things are left unspoken. D) Cohesiveness is a desirable group characteristic that is associated with positive group outcomes.

ANS: D. Cohesiveness is a desirable group characteristic that is associated with positive group outcomes. Cohesiveness is a desirable group characteristic that is associated with positive group outcomes. It is not common for the group to be cohesive during the first meeting of the group. During the first meeting, or the initial stage, members introduce themselves and the parameters of the group are established. Group members begin to ìcheck outî one another and the leaders as they determine their levels of comfort in the group setting. Cohesiveness is associated with the working stage of a group that may take two or three sessions in a therapy group because members must develop some level of trust before sharing personal feelings or difficult situations. If a group is ìoverly cohesive,î in that uniformity and agreement become the group's implicit goals, there may be a negative effect on the group outcome as members may not offer needed feedback and this may thwart critical thinking and creative problem solving. Group cohesiveness is the degree to which members work together cooperatively to accomplish the purpose.

19. The nurse assesses fine hand tremors in a patient with a history of heavy alcohol use. If the nurse understands that the tremors are a direct result of alcohol use, the nurse is using which pattern of knowing, according to Carper? A) Aesthetic knowing B) Ethical knowing C) Personal knowing D) Empirical knowing

ANS: D. Empirical knowing Empirical knowing is obtained from the science of nursing. An example would be a client with panic disorder begins to have an attack. Panic attack will raise pulse rate. Personal knowing is obtained from life experience. An example would be a client's face shows the panic. Ethical knowing is obtained from the moral knowledge of nursing. An example is although the nurse's shift has ended, she remains with the client. Aesthetic knowing is obtained from the art of nursing. Although the client shows outward signals now, the nurse has sensed previously the client's jumpiness and subtle differences in the client's demeanor and behavior.

25. During the initial interview with a client in crisis, the initial priority is to A) assess the adequacy of the support system. B) assess for substance use. C) determine the precrisis level of functioning. D) evaluate the potential for self-harm.

ANS: D. Evaluate the potential for self harm Safety is always the priority; clients in crisis may be suicidal. Assessing the adequacy of the support system, assessing for substance use, and determining the precrisis level of functioning would be important assessments but not as high priority as evaluating the potential for self-harm.

5. The nurse initiating a therapeutic relationship with a client should explain the purpose, which is to A) alleviate stressors in life. B) allow the client to know the nurse's feelings. C) establish relationships. D) facilitate a positive change

ANS: D. Facilitate a positive change The client who has unmet or unsatisfactorily met needs seeks to make changes; the nurse facilitates this desire to change. The focus of the therapeutic relationship is on the client's needs, not the nurse's. The orientation phase begins when the nurse and client meet and ends when the client begins to identify problems to examine. During the orientation phase, the nurse establishes roles, the purpose of meeting, and the parameters of subsequent meetings; identifies the client's problems; and clarifies expectations.

3. A patient has just been told she has cervical cancer. When asked about how this is impacting her, she states, ìIt's just an infection; it will clear up.î The statement indicates that this patient A) needs education on cervical cancer. B) is unable to express her true emotions. C) should be immediately referred to a cancer support group. D) is using denial to protect herself from an emotionally painful thought.

ANS: D. Is using denial to protect herself from an emotionally painful thought Ego defense mechanisms are methods of attempting to protect the self and cope with basic drives or emotionally painful thoughts, feelings, or events. Most defense mechanisms operate at the unconscious level of awareness, so people are not aware of what they are doing and often need help to see the reality. Education and referrals are premature at this point in the patient's ability to cope.

26. Patients on an inpatient psychiatric unit can earn off-unit privileges for daily use of socially appropriate behavior. This is an example of employing which concept of behavior modification? A) Systematic desensitization B) Negative reinforcement C) Classical conditioning D) Operant conditioning

ANS: D. Operant conditioning The theory of operant conditioning says people learn their behavior from their history or past experiences, particularly those experiences that were repeatedly reinforced. Behavior that is rewarded with reinforcers tends to recur. Positive reinforcers that follow a behavior increase the likelihood that the behavior will recur. In classical conditioning, behavior can be changed through conditioning with external or environmental conditions or stimuli. Negative reinforcement involves removing a stimulus immediately after a behavior occurs so that the behavior is more likely to occur again. In systematic desensitization, the client learns and practices relaxation techniques to decrease and manage anxiety. He or she is then exposed to the least anxiety provoking situation and uses the relaxation techniques to manage the resulting anxiety.

10. A nursing supervisor reprimands an employee for being chronically late for work. If the employee handles the reprimand using the defense mechanism of displacement, he would most likely do which of the following? A) Argue with the supervisor that he is usually on time B) Make a special effort to be on time tomorrow C) Tell fellow employees that the supervisor is picking on him D) Tell the unit housekeeper that his work is sloppy

ANS: D. Tell the unit housekeeper that his work is sloppy Displacement involves venting feelings toward another, less threatening person. Arguing is denial. Making a special effort is compensation. Telling fellow employees that the supervisor is picking on him is projection.

23. One of the primary differences between social and therapeutic relationships is the A) amount of emotion invested. B) degree of satisfaction obtained. C) kind of information given. D) type of responsibility involved.

ANS: D. Type of responsibility involved The nurse has the responsibility for the therapeutic relationship. The therapeutic relationship focuses on the needs, experiences, feelings, and ideas of the client only. A social relationship is primarily initiated for the purpose of friendship, socialization, companionship, or accomplishment of a task.

27. A patient states, ìI hate spending time with my family. They're always on my back about something! I won't do anything they ask me to do.î Which response by the nurse reflects a behavioral perspective? A) ìLet's play like I'm your parent, and we'll practice some better ways to communicate that won't result in an argument.î B) ìSome medicines really help with anger. Are you interested in talking to your physician about starting you on something?î C) ìThat's probably your way of getting back at them for being strict with you when you were younger.î D) ìIf you agree to start doing what your parents request, then they have agreed to respect your privacy more.î

ANS: D. ìIf you agree to start doing what your parents request, then they have agreed to respect your privacy more. Behaviorism is a school of psychology that focuses on observable behaviors and what one can do externally to bring about behavior changes. It does not attempt to explain how the mind works. Behavior can be changed through a system of rewards and punishments. Practicing communication is a psychotherapy technique to improve interpersonal relationships. Use of medications is not grounded in behavioral perspective. Analyzing the reasons for the behavior is not grounded in behavioral perspective.

29. A patient is blaming his impending divorce on the fact that his wife goes out frequently with her girlfriends. If using reality therapy, the nurse would help the patient with which of the following responses? A) ìIf you really love her, she should love you as well.î B) ìWhat does being divorced mean for you?î C) ìHow do you feel about your marriage ending?î D) ìWhat role do you think you have played in the end of your marriage?

ANS: D. ìWhat role do you think you have played in the end of your marriage? Reality therapy challenges clients to examine the ways in which their own behavior thwarts their attempts to achieve life goals. Others are often assigned the blame when people hold onto irrational thinking. The search for meaning is associated with logotherapy. Exploring feelings are associated with gestalt therapy.

20. Which is included in Healthy People 2020 objectives? A) To decrease the incidence of mental illness B) To increase the number of people who are identified, diagnosed, treated, and helped to live healthier lives C) To provide mental health services only in the community D) To decrease the numbers of people who are being treated for mental illness

ANS; B. To increase the number of people who are identified, diagnosed treated and helped to live healthier lives One of the Healthy People 2020 objectives is to increase the number of people who are identified, diagnosed, treated, and helped to live healthier lives. It may not be possible to decrease the incidence of mental illness. At this time, the focus is on ensuring that persons with mental illness are receiving needed treatment. It may not be possible or desirable to provide mental health services only in the community.

17. Which of the following is the priority of the Healthy People 2020 objectives for mental health? A) Improved inpatient care B) Primary prevention of emotional problems C) Stress reduction and management D) Treatment of mental illness

Ans D. Treatment of mental illness The objectives are to increase the number of people who are identified, diagnosed, treated, and helped to live healthier lives. The objectives also strive to decrease rates of suicide and homelessness, to increase employment among those with serious mental illness, and to provide more services both for juveniles and for adults who are incarcerated and have mental health problems. Answer choices A, B, and C are not priorities of Healthy People 2020.

10. The creation of asylums during the 1800s was meant to A) improve treatment of mental disorders. B) provide food and shelter for the mentally ill. C) punish people with mental illness who were believed to be possessed. D) remove dangerous people with mental illness from the community.

Ans. B provide food and shelter for the mentally ill The asylum was meant to be a safe haven with food, shelter, and humane treatment for the mentally ill. Asylums were not used to improve treatment of mental disorders or to punish mentally ill people who were believed to be possessed. The asylum was not created to remove the dangerously mentally ill from the community.

34. A client is fearful and reluctant to talk. Which of the following techniques is most effective when trying to engage the client in interaction? A) Broad opening B) Focusing C) Giving information D) Silence

Ans: A Broad Opening Broad openings allow the client to say as much or little as he or she wants. Focusing (concentrating on a single point) can be intimidating; giving information (making available the facts that the client needs) and silence do not encourage client interaction.

21. The nurse should use clear concrete messages when working with patients displaying which of the following conditions? Select all that apply. A) Anxiety B) Anorexia C) Dementia D) Schizophrenia E) Hypochondriasis

Ans: A, C, D A) Anxiety C) Dementia D) Schizophrenia Clients who lose cognitive processing, such as those who are anxious, cognitively impaired, or suffering from some mental disorders, often function at a concrete level of comprehension and have difficulty answering abstract questions. The nurse must be sure that statements and questions are clear and concrete.

22. Which statements are true of concrete and abstract messages? Select all that apply. A) Abstract messages include figures of speech that are difficult to interpret. B) Abstract messages are important for accurate information exchange. C) Concrete messages require the listener to interpret what the speaker says. D) Concrete messages are clear, direct, and easy to understand. E) Abstract messages are best used for persons who are anxious.

Ans: A, D A) Abstract messages include figures of speech that are difficult to interpret. D) Concrete messages are clear, direct, and easy to understand. Abstract messages include figures of speech that are difficult to interpret. Concrete messages are clear, direct, and easy to understand. Concrete (not abstract) messages are important for accurate information exchange. Abstract (not concrete) messages require the listener to interpret what the speaker says. Concrete (not abstract) messages are best used for persons who are anxious.

28. Patient says to the nurse, ìI wonder what's playing at the movie tonight.î The most therapeutic response would be, A) ìAre you telling me you would like to go to the movies?î B) ìWhy don't you look in the newspaper.î C) ìThere's nothing worth watching.î D) ìDo you like to go to the movies?î

Ans: A. Are you telling me you would like to go to the movies Verbalizing the impliedóvoicing what the client has hinted at or suggested. Putting into words what the client has implied or said indirectly tends to make the discussion less obscure. The nurse should be as direct as possible without being unfeelingly blunt or obtuse. The client may have difficulty communicating directly. The nurse should take care to express only what is fairly obvious; otherwise, the nurse may be jumping to conclusions or interpreting the client's communication.

18. Which of the following is the best reason that many psychiatric care units have policies against clients touching one another or staff? A) Because some clients with mental illness have difficulty knowing when touch is or is not appropriate B) Because clients often perceive being touched as a threat and may attempt to protect himself or herself by striking the staff person C) Because it can be threatening to both the client and the nurse D) Because touching always leads to more touching.

Ans: A. Because some clients with mental illness have difficulty knowing when touch is or is not appropriate Some clients with mental illness have difficulty understanding the concept of personal boundaries or knowing when touch is or is not appropriate. Consequently, most psychiatric inpatient, outpatient, and ambulatory care units have policies against clients touching one another or staff. When a staff member is going to touch a client while performing nursing care, he or she must verbally prepare the client before starting the procedure. A client with paranoia may interpret being touched as a threat and may attempt to protect himself or herself by striking the staff person. Both the client and the nurse can feel threatened if one invades the other's personal or intimate zone, which can result in tension, irritability, fidgeting or even flight. Touching can be comforting and supportive when it is welcome and

31. The client stated, ìI was so upset about my sister ignoring me when I was talking about being ashamed.î Which nontherapeutic communication technique would the nurse be using if the nurse would state, ìHow are your stress reduction classes going?î A) Changing the subject B) Offering advice C) Challenging D) Disapproving

Ans: A. Changing the subject The nurse did not respond to the client's statement and instead introduced an unrelated topic. Advising would be telling the client what to do. Challenging would be demanding proof from the client. Disapproving would be denouncing the client's behavior or ideas.

20. Which of the following distance zones is acceptable for people who mutually desire personal contact? A) Social B) Intimate C) Personal D) Public

Ans: B. Intimate The intimate zone is the amount of space that is comfortable for parents with young children and those who desire personal contact. The social zone is the distance acceptable for communication in social, work, and business settings. The personal zone is comfortable between family and friends who are talking. The public zone is an acceptable distance between a speaker and an audience.

29. The client says to the nurse, ìI have special powers because I am the mother of God. I can heal everyone in the hospital.î The nurse's best response would be, A) ìThat sounds interesting. What can you do?î B) ìIt would be unusual for anyone to have that kind of power.î C) ìYou could not heal everyone. No one has that much power.î D) ìWell, you can certainly try.î

Ans: B. It would be unusual for anyone to have that kind of power When the nurse states, ìIt would be unusual for anyone to have that kind of power,î the nurse is voicing doubt or expressing uncertainty about the reality of the client's perceptions. The other choices have demeaning connotations toward the client and should not be used.

26. A patient is sitting alone, slouched, with eyes closed. The nurse approaches. Which statement is most likely to encourage the patient to talk? A) ìIf you are sleepy, would you like me to help you back to your room?î B) ìYou look like you are deep in thought.î C) ìIs something wrong?î D) ìWhy are you sitting with your eyes closed?î

Ans: B. You look like you are deep in thought Making observationsóverbalizing what the nurse perceives. Sometimes clients cannot verbalize or make themselves understood. Or the client may not be ready to talk.

30. During the admission interview, the nurse asks the client what led to his hospitalization. The client responds, ìThey lied about me. They said I murdered my mother. You're the killers. You all killed my mother. She died before I was born.î The best initial response by the nurse would be, A) I just saw your mother. She's fine B) You're having very frightening thoughts C) We'll put you in a private room until you're in better control D) If your mother died before you were born. You wouldn't be here

Ans: B. You're having very frightening thoughts When the nurse states, ìYou're having very frightening thoughts,î the nurse is verbalizing the implied or voicing what the client has hinted or suggested. The other responses would not be the best initial response in this situation. ìI just saw your mother. She's fine.î ìYou're having very frightening thoughts.î ìWe'll put you in a private room until you're in better control.î ìIf your mother died before you were born, you wouldn't be here.î B

4. A client grieving the recent loss of her husband asks if she is becoming mentally ill because she is so sad. The nurse's best response would be, A) ìYou may have a temporary mental illness because you are experiencing so much pain.î B) ìYou are not mentally ill. This is an expected reaction to the loss you have experienced.î C) ìWere you generally dissatisfied with your relationship before your husband's death?î D) ìTry not to worry about that right now. You never know what the future brings.î

Ans: B. ìYou are not mentally ill. This is an expected reaction to the loss you have experienced Mental illness includes general dissatisfaction with self, ineffective relationships, ineffective coping, and lack of personal growth. Additionally the behavior must not be culturally expected. Acute grief reactions are expected and therefore not considered mental illness. False reassurance or overanalysis does not accurately address the client's concerns.

24. A patient remarks, ìYou know, it's the same thing every time.î The nurse should respond by stating, A) I understand B) I'm sure everyone is doing their best C) I'm not sure what you mean. Please explain D) It's the same thing every time?

Ans: C. I'm not sure what you mean. Please explain Consensual validationósearching for mutual understanding, for accord in the meaning of the words. For verbal communication to be meaningful, it is essential that the words being used have the same meaning for both (all) participants. Sometimes, words, phrases, or slang terms have different meanings and can be easily misunderstood.

13. Before the period of the enlightenment, treatment of the mentally ill included A) creating large institutions to provide custodial care. B) focusing on religious education to improve their souls. C) placing the mentally ill on display for the public's amusement. D) providing a safe refuge or haven offering protection.

Ans: C. Placing the mentally ill on display doe the publics amusement In 1775, visitors at St. Mary's of Bethlehem were charged a fee for viewing and ridiculing the mentally ill, who were seen as animals, less than human. Custodial care was not often provided as persons who were considered harmless were allowed to wander in the countryside or live in rural communities, and more dangerous lunatics were imprisoned, chained, and starved. In early Christian times, primitive beliefs and superstitions were strong. The mentally ill were viewed as evil or possessed. Priests performed exorcisms to rid evil spirits, and in the colonies, witch hunts were conducted with offenders burned at the stake. It was not until the period of enlightenment when persons who were mentally ill were offered asylum as a safe refuge or haven offering protection at institutions.

32. During the mental status assessment, the client expresses the belief that the CIA is stalking him and plans to kidnap him. The best response by the nurse would be, A) ìThat makes no sense at all.î B) ìYou can tell me about that after I finish asking these questions.î C) ìWhat kinds of things have been happening?î D) ìWhy would the CIA be interested in you?î

Ans: C. What kinds of things have been happening? When the nurse responds, ìWhat kinds of things have been happening?î the nurse is seeking information. ìThat makes no sense at all,î is inappropriate because it may make perfect sense to the client. ìYou can tell me about that after I finish asking these questions,î shows that the nurse is not interested in what the client has to say. ìWhy would the CIA be interested in you,î feeds into the notion that the CIA is stalking the client.

25. A patient states, ìRight before I got here I was doing alright. My job was going well, my wife and I were happy, and we just moved into a new apartment.î The nurse responds, ìYou said you and your wife were happy. Tell me more about that.î This is an example of which therapeutic technique? A) Encouraging comparison B) General lead C) Restating D) Exploring

Ans: D. Exploring Exploringódelving further into a subject or an idea. When clients deal with topics superficially, exploring can help them examine the issue more fully. Any problem or concern can be better understood if explored in depth.

19. A client has been making sexual comments when communicating with the nurse. The nurse wants to spend some time talking to the patient while respecting the patient's right to privacy. Which setting would be the most appropriate setting for the nurse to talk with the client? A) In the patient's room when the patient's roommate is present and 3 feet away B) At the nurse's station when other clients and visitors are less than 4 feet away C) In an interview room in a remote section of the unit with the nurse 1 foot away from the patient D) In a quiet corner of the dayroom at least 4 feet away from others

Ans: D. In a quiet corner of the dayroom at least 4 feet away from others A quiet corner of the dayroom at least 4 feet away from others would allow the patient privacy while being to deter any inappropriate activity would be the most appropriate setting. Being in the patient's room when the patient's roommate is present and 3 feet away or at the nurse's station when other patients and visitors are less than 4 feet away would not allow for the patient's privacy. An interview room in a remote section of the unit would not be a good choice as the area is too isolated. Additionally, the nurse should maintain a distance of more than 1.5 feet away from the patient as closer distances are within the intimate zone.

33. The nurse is trying to obtain some information about family relationships from the client. Which of the following statements is best? A) ìIs it upsetting for you to talk about your family?î B) ìIs your family ready for you to come home?î C) ìSo, how is your family?î D) ìTell me your feelings about your family situation.î

Ans: D. Tell me your feelings about your family situation This statement asks the client to describe or discuss family; all other statements might get only one-word answers.

27. A patient yells, ìAll the nurses here are so mean. None of you really care about us!î The most therapeutic response would be, A) ìI cannot allow you to yell like that.î B) ìWe care about you.î C) ìOh, really?î D) ìYou seem very irritated.î

Ans: D. You seem very irritated Reflectingódirecting client actions, thoughts, and feelings back to client. Reflection encourages the client to recognize and accept his or her own feelings. The nurse indicates that the client's point of view has value and that the client has the right to have opinions, make decisions, and think independently.

14. The first training of nurses to work with persons with mental illness was in 1882 in which state? A) California B) Illinois C) Massachusetts D) New York

C. Massachusetts The first training for nurses to work with persons with mental illness was in 1882 at McLean Hospital in Belmont, Massachusetts.

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