Psych Nursing Quiz 1

To assess whether a school-age child is satisfactorily resolving the industry versus inferiority psychosocial crisis, what question should the nurse ask the parent? · "Is your child able to bathe and get dressed daily without your help?" · "What is your child's reaction when you are separated for an extended period of time?" · "How would you describe your child's academic, physical, and social accomplishments?" · "What do you think are the strongest and weakest features of the relationship between you and your child?"

"How would you describe your child's academic, physical, and social accomplishments?" Rationale The correct response assesses developing social, physical, and school skills. During this stage, the child's task is to gain a sense of personal abilities and competence and to expand relationships. Attainment of this task (industry) brings with it the virtue of confidence and, later in like, competence and an ability to work. The ability of the child to get dressed daily, the child's reaction upon separation, and the strongest and weakest features of the parent-child relationship relate to other psychosocial crises. p. 21

A client asks the nurse, "Do you think God punishes people for having evil thoughts? Which response by the nurse is most therapeutic? · "Evil has been with us since the beginning of mankind." · "My faith teaches that God is filled with love and forgiveness." · "It sounds like you are feeling some difficulties about your faith." · "Let's read the Bible together to see if we can answer that question."

"It sounds like you are feeling some difficulties about your faith." Rationale Some clients seek forgiveness because of hurt they have caused others or because of rejection from others because of their psychiatric illness. Many clients rely on God as their source of strength and maintain a deep, abiding faith despite the circumstances of their illnesses. Maintaining appropriate boundaries with these clients is paramount. Clients may have difficulty in knowing where their own beliefs stop and those of the health care professional begin. The client is vulnerable to influence by someone with strong beliefs. In meeting the spiritual needs of psychiatric clients, nurses must be continually aware and respectful of boundary issues and never impose beliefs on the client. p.16

The psychiatric mental health nurse that is politically active by lobbying congressional representatives to help improve and expand mental health care is demonstrating what attribute of the art of nursing? · Attending · Advocacy · Courage · Clarity

Advocacy Rationale The psychiatric mental health nurse that is politically active by lobbying congressional representatives to help improve and expand mental health care is demonstrating client advocacy. Attending refers to an intensity of presence, being there for and in tune with the client. Courage and clarity are not specifically identified as attributes of the art of nursing. p. 6

The nurse actively listens to a client while making eye contact and placing a gentle hand on the client's shoulder. What is the nurse demonstrating? · Attending · Advocacy · Self-care · Informing

Attending Rationale The nurse is demonstrating attending, which refers to an intensity of presence, being there for and in tune with the client. A client advocate is one who speaks for another's cause. Self-care is demonstrated when the nurse ensures his or her own well-being. The nurse is not informing the client, which would likely be nontherapeutic at this time. p.6

What is the underlying premise associated with behavioral therapy? · Behavior is learned and can be modified · Behavior is a product of unconscious drives · Motives must change before behavior changes · Behavior is determined by cognitions; change in cognitions produces new behavior

Behavior is learned and can be modified Rationale The premise underlying behavioral therapy is that behavior is learned and can be modified. Behaviorists agree that behavior can be changed without insight into the underlying cause. Behavioral therapy does not hold that behavior is a product of unconscious drives, that motives must be changed before behavior changes, or that behavior is determined by cognitions. Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end of an exam may trigger your mind with the answer or provide an important clue to an earlier question. p. 23

A nurse is caring for a client who is agitated. Which medication should the nurse anticipate will be prescribed to calm the client? · Ibuprofen · Clonazepam · Acetaminophen · Chlorpromazine

Chlorpromazine Rationale Chlorpromazine has a calming effect on the agitated person, and discovery of this effect in 1952 changed the psychological focus on treating mental illnesses in the United States. Ibuprofen may have an analgesic effect, but it will not calm an agitated person. Clonazepam is an anti-seizure medication that is sometime used for clients with mental disorders, though it causes heavy sedation rather than just a calming effect. Like ibuprofen, acetaminophen is used for reducing pain and fever. P.25

A nurse who needs to obtain research findings understands that he or she can use what source? Select all that apply. · Primary health care provider · Clinical practice guidelines · Health care policy · Clinical algorithms · Internet resources

Clinical practice guidelines Clinical algorithms Internet resources Rationale The nurse may obtain research findings through clinical practice guidelines, clinical algorithms, and internet resources. The primary health care provider and health care policy are not sources for obtaining research. p.7

A nurse is assessing behavior patterns in clients based on age- appropriate development. Which developmental model should the nurse apply? · Erik Erikson's eight stages of development · Harry Stack Sullivan's interpersonal theory · Freud's psychosexual stages of development · Hildegard Peplau's theory of interpersonal relationships

Erik Erikson's eight stages of development Rationale Erik Erikson's eight stages of development help to identify age-related normal development and interpersonal skills. Harry Stack Sullivan's interpersonal theory deals with developing a psychotherapeutic environment to promote healthy interactions with clients. Freud's psychosexual stages of development present a theory that describes the reason for possible behaviors that arise due to conflicts during the developmental stages. Hildegard Peplau's theory of interpersonal relationships more effectively describes the theory of anxiety and its implications on learning. p. 26

Which term applies to planning and implementing elective care based on current valid research · Competence · Holistic practice · Advanced practice · Evidence-based practice

Evidence-based practice Rationale Evidence-based practice refers to optimal nursing care resulting from integrating the best current evidence from valid research. Competence refers to overall ability and quality. Holistic practice refers to practice which considers biological, psychological, social, spiritual, and cultural issues. Advanced practice refers to autonomous practice with specialty privileges and is beyond the basic level. p. 16

According to cognitive theory, mental illness is caused by a faulty psychological process that can be corrected by increasing one's personal insight and understanding. Which factor challenges that this theory is not always correct? · Invention of insulin shock therapy · Development of psychosurgery techniques · Identifying the effects of chlorpromazine · Identification of specific agents that cause mental illness

Identifying the effects of chlorpromazine Rationale Chlorpromazine (Thorazine) is known to have a calming effect on agitated clients. The finding indicates that psychiatric illness may respond to medications that alter the intercellular components. This implies that the mental illness is also caused by disruption of intercellular components. This theory rejected the earlier psychological theory which stated that mental illness is caused by a faulty psychological process that can be corrected by increasing personal insight and understanding. Insulin shock therapy and psychosurgery techniques (surgery on specific parts of the brain) are invasive techniques that were used to modify behavior. Germ theory stated that mental illness is caused by a specific agent that is identifiable and can be eliminated. This is an old theory of the cause of mental illness and was disproved, because a single agent causing mental illness was not identified. p. 25

What provides the framework for identifying appropriate nursing interventions for dealing with the phenomena a client with a mental health disorder is experiencing? · Nursing diagnosis · DSM-5 diagnosis · Traditional helping strategy · Western-style psychotherapy

Nursing diagnosis Rationale The nursing diagnosis provides the framework for identifying appropriate nursing interventions for dealing with the phenomena a client with a mental health disorder is experiencing. The DSM-5 defines the psychiatric diagnosis. Traditional helping strategies are therapies that include storytelling. Western-style psychotherapy is a therapeutic intervention unlikely to be used in many other cultures. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple choice items. IN you are uncertain about a question, eliminate the choices you believe are wrong, and then call on your knowledge, skills, and abilities to choose from the remaining responses.p.15

During an assessment interview, the nurse finds that a native Alaskan client reports having a strong desire to remove his clothes and expose himself outside in the winter. What term should the nurse to document this condition? · Pibloktoq · Schizophrenia · Bipolar mood disorder · Obsessive-compulsive disorder (OCD)

Pibloktoq Rationale Different cultures have different norms for acceptable and unacceptable behavior. In Greenland and Alaska, pibloktoq is a syndrome in which a person has a strong desire to remove one's clothes and expose oneself in winter. Schizophrenia is a delusional disorder. Bipolar mood disorder and Obsessive-compulsive disorder (OCD) are mood disorders and not culture-bound syndromes. P.15

Which nursing activity demonstrates the role of a professional psychiatric nurse as identified by Hildegard Peplau? · Managing the milieu · Providing counseling · Documenting client behaviors · Caring for the client's physiological needs

Providing counseling Rationale Hildegard Peplau identified the role of counselor or psychotherapist as the heart of psychiatric nursing and a role unique to this nursing specialty. Managing the milieu, attending to the client's physiological needs, and documenting client behaviors and responses are responsibilities of all professional nurses and are not unique to the role of a psychiatric nurse. p. 23

The nursing unit that uses data to monitor client outcomes is addressing which competency? · Evidence-based practice · Quality improvement · Safety · Patient-centered care

Quality improvement Rationale The utilization of data to monitor client outcomes is an example of addressing quality improvement. This does not address evidence-based practice, safety, or patient- centered care.

What provides the strongest evidence on which to base clinical practiced · Randomized controlled studies · Single descriptive or qualitative study · Opinion of authorities or reports of expert committees · Single nonexperimental study

Randomized controlled studies Rationale Along with systematic reviews or meta-analyses, randomized controlled studies provide the strongest evidence on which to base clinical practice. A single descriptive or qualitative study, the opinion of authorities or reports of expert committees, and a single nonexperimental study are lower on the hierarchical rating system of evidence. Test-Taking Tip: After you have eliminated one or more choices, you may discover that two of the options are very similar. This can be helpful, because it may mean that one of these look-alike answers is the best choice and the other is a very good distractor. Test both of these options against the stem. Ask yourself which one completes the incomplete statement grammatically and which one answers the question more fully and completely. The option that best completes or answers the stem is the one you should choose. Here, too, pause for a few seconds, give your brain time to reflect, and recall may occur. p. 4

Considering Freud's psychoanalytical theory, which level of awareness would the nurse evaluate for clients suffering from emotions related to trauma? · Ego · Conscious · Unconscious · Preconscious

Unconscious Rationale The unconscious level includes memories and urges that are socially unacceptable or trauma-related emotions, which are placed deep inside as the client finds it painful to cope with them. The ego is the problem solver, which can differentiate between subjective and objective reality. The conscious level includes all memories and perceptions that the client is aware of at a given time. The preconscious level includes memories and emotions that can be retrieved with conscious effort. pp. 20-21

Which statement by an 86-year-old client reflects successful resolution of the expected psychosocial crisis? · "I enjoy being retired and having time to myself. Sometimes I go 2 or 3 weeks without seeing anyone." · "After my spouse died 5 years ago, my siblings and I have become closer. That gives me a sense of contentment." · "I worked all my life to take care of my family, but my kids never come to see me. That's okay because I like being alone." · "I had chemotherapy for colon cancer 3 years ago. Since then, I do not have much energy, so I quit going to activities at the senior center."

· "After my spouse died 5 years ago, my siblings and I have become closer. That gives me a sense of contentment." Rationale According to Erikson, integrity versus despair is the psychosocial crisis of this developmental group. Successful completion of this task leads to a sense of integrity and fulfillment. This client has maintained meaningful relationships with others, despite the loss of a spouse. Going 2 or 3 weeks without seeing anyone, never having one's children come to visit, and not going to outside activities indicate despair, represented by social isolation. p. 22

Using Maslow's pyramid, which comment by a client should the nurse assign the highest priority? · "I feel so alone. I wish I had someone special in my like." · "I did not do a good job on the project my supervisor assigned." · "I live too far from art and history museums to visit them as often as I would like." · "Four robberies and three assaults occurred in my neighborhood in the past month."

· "Four robberies and three assaults occurred in my neighborhood in the past month." Rationale The correct response recognizes a threat to the client's sense of safety, which is a higher priority for the nurse's attention than love and belonging, esteem, and sell- actualization, represented by the other responses.

Which question should the nurse ask in order to assess a client's cognitive ability to think clearly? · "Are you employed full time?" · "Do you feel guilty about your recent divorce?" · "How do you plan to afford getting your own apartment?" · "What do you think is your most valuable personal characteristic?"

· "How do you plan to afford getting your own apartment?" Rationale Clear thinking is demonstrated by the ability to problem solve using good judgement and logical reasoning to arrive at an insightful conclusion. Clear thinking would be demonstrated by arriving at a plan to live independently that demonstrates those qualities. Employment demonstrates productivity; identifying valuable personal characteristics is associated with a healthy sense of sell-value; undue guilt reflects the inability to manage anxiety and fear. P11

What statement by a client warrants the nurse to advocate on behalf of the client? · "I am so glad I am admitted to the hospital. I just want to get better." · "I understand everything about my procedure." · "I do not want anymore chemo treatments. I just want to die in peace." · "Can you tell me what time I will be discharged from the hospital?"

· "I do not want anymore chemo treatments. I just want to die in peace." Rationale The statement, "I do not want anymore chemo treatments. I just want to die in peace," warrants the nurse to advocate on behalf of the client's request to discontinue chemotherapy treatments. The client who is glad to be in the hospital, understands everything about his or her procedure, or wants to know what time he or she is being discharged does not warrant advocacy. Test-Taking Tip: Look for answers that focus on the patient or are directed toward feelings.p.6

Which statement by the nurse most clearly communicates the art of caring? · "I will let your health care provider know that you do not want any more treatments." · "Push the call button when you need assistance to the bathroom, I want to assist you so you do not fall." · "I would like to sit down and listen to you, but I need to go check on another client." · "I will stay with you throughout the procedure and keep you comfortable afterward."

· "I will stay with you throughout the procedure and keep you comfortable afterward." Rationale "I will stay with you throughout the procedure and keep you comfortable afterward," conveys the art of caring to the client. "I will let your health care provider know that you do not want any more treatments," is a statement of advocacy. "Push the call button when you need assistance to the bathroom, I want to assist you so you do not fall," reinforces client safety. "I would like to sit down and listen to you, but I need to go check on another client," is inappropriate, because it makes the client feel that the nurse does not have time for him or her. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking, and look for key words; (2) read each answer thoroughly, and see if it completely covers the material the question asks; and (3) narrow the choices by immediately eliminating answers you know are incorrect. p. 6

Which statement by the nurse best demonstrates a dilemma associated with utilization of evidence-based practice (EBP) in the mental health clinical setting? · "The client can't afford the cost of the medication prescribed." · "I am unhappy with the new changes made to the shift schedule." · "The client doesn't see the benefit of changing to this new form of therapy." · "It's difficult to review the literature about this new treatment when we are short staffed."

· "It's difficult to review the literature about this new treatment when we are short staffed." Rationale Dilemmas associated with the utilization of EBP include the practical issue of nursing environments that are short staffed and dealing with budgetary constraints making it difficult to spend time and money on the evaluation of the literature in order to make decisions of clinical practice based on best evidence. The affordability of the medication, schedule dissatisfaction, and client compliance are unrelated to EBP. p. 4

Which scenario meets criteria for "normal" behavior? · An 8-year-old's only verbalization is "no no no." · A 16-year-old usually sleeps for 3 or 4 hours per night. · A 64-year-old has difficulty remembering grandchildren's names. · A 43-year-old cries privately for 1 month after the death of a spouse.

· A 43-year-old cries privately for 1 month after the death of a spouse. Rationale Crying privately for 1 month after the death of a spouse is normal mourning behavior. An 8-year-old whose only verbalization is "no no no" shows signs of developmental delays. A 16-year-old who sleeps for 3 or 4 hours each night may have a sleeping disorder. A 64-year-old with difficulty remembering grandchildren's names may be showing signs of dementia.

The nurse planning care for a 14-year-old should include interventions to help the client achieve which developmental task? · Establish trust · Gain autonomy · Achieve identity · Develop a sense of industry

· Achieve identity Rationale According to Erikson, the task of adolescence is to achieve identity rather than to be left in role confusion. A sense of identity is essential to making the transition into adulthood. The task of establishing trust is for infancy, so this response is incorrect. The task of gaining autonomy is the task slated for early childhood. School-aged children are tasked with developing a sense of industry. pp. 21-21, 26

The nursing staff identifies several practices that need to change to improve client outcomes. Using the 5 As, what is the next step? · Appraise the literature · Apply the evidence · Acquire literature · Ask a question

· Acquire literature Rationale The nursing staff has completed the first step, asking a question and identifying the problem. The next step is acquiring literature, which involves searching the literature for scientific studies and articles that address issue(s) of concern. Appraising the literature is the third step in the process. Applying evidence is the fourth step.

To which human characteristic is resilience most closely related? · Adaptation · Spirituality · Self-confidence · Self-actualization

· Adaptation Rationale Resilience is associated closely with the process of adapting and helps people facing tragedies, loss, trauma, and severe stress. Resilience refers to an ability and capacity to secure resources needed to support one's well-being. Spirituality relates to one's search for the meaning of life, a relationship with a higher being, and adherence to transcendent values. Self-confidence is the result of intact sell-image and self-esteem. Self-actualization is part of Maslow's hierarchy of needs.

What area of the art of nursing may a client who lacks knowledge, skills, ability, or status to speak for him or herself most need from the nurse? · Attending · Advocacy · Empathy · Caring

· Advocacy Rationale A client who lacks knowledge, skills, ability, or status to speak for him- or herself may require advocacy. Attending and caring are important as well, but advocacy is unique to the description of the client. Empathy is a component of caring. Test-Taking Tip: Do not worry if you select the same numbered answer repeatedly, because there usually is no pattern to the answers. p. 6

When considering prevalence, the nurse will focus on providing community mental health screening for which disorder? · Anxiety disorders · Affective disorders · Alcohol dependence · Any substance abuse

· Anxiety disorders Rationale Over a 12-month period, anxiety disorders have an 18.1% prevalence affecting an estimated 57 million people. Affective disorders have a 9.5% prevalence (30 million); Alcohol dependence has a 6.3% prevalence (16.5 million); any substance abuse has a prevalence of 9.4% (24.6 million). p. 12

The nurse observes that a client diagnosed with major depression does not participate in any activity on the unit. Which of the 5 A's in the multistep process of integrating evidence-based practice into care is the nurse using? · Appraise the literature · Assess the performance · Ask a question · Apply the evidence

· Ask a question Rationale The nurse is asking a question. Asking a question includes identifying a problem or need for change for a specific client or situation. Evaluating and synthesizing the research regarding its validity, relevance, and applicability using criteria of scientific merit is an example of appraising the literature. Evaluating the outcomes, using clearly defined criteria and reports, and documenting results is an example of assessing the performance. Applying the evidence involves choosing an intervention based on the best available evidence with the understanding of the client's preference and needs. Test-Taking Tip: Start by reading each of the answer options carefully. Usually at least one of them will be clearly wrong. Eliminate this one from consideration. Now you have reduced the number of response choices by one and improved the odds. Continue to analyze the options. If you can eliminate one more choice in a four-option question, you have reduced the odds to 50/50. While you are eliminating the wrong choices, recall often occurs. One of the options may serve as a trigger that causes you to remember what a New seconds ago had seemed completely forgotten. P.3

After implementing the interventions necessary to improve client outcomes, what is the next step in integrating evidence-based practice into clinical practiced? · Assess the performance · Apply the evidence · Ask a question · Appraise the literature

· Assess the performance Rationale After implementing the interventions identified necessary to improve client outcomes, the next step is assessing the performance. Applying the evidence is the implementation process, asking a question identifies the problem or a need for change, and appraising the literature allows for evaluation of current research.

Which nursing theorist identified the impact of internal and external stressors on the equilibrium of the system as the focus of the theory? · Betty Neuman · Patricia Benner · Dorothea Orem · Sister Callista Roy

· Betty Neuman Rationale Betty Neuman's theory focuses on the impact of internal and external stressors on the equilibrium of the system. She implemented stress-reducing strategies for the client. Patricia Benner's theory focuses on caring as a foundation for nursing. Dorothea Orem's theory focuses on the goal of self-care as an integral part of nursing practice. Sister Callista Roy's theory focuses on the continuous need for physical, psychological, and social adaptation. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. P. 24

Current information suggests that the most disabling mental disorders are the result of what? · Biological influences · Psychological trauma · Learned ways of behaving · Faulty patterns of early nurturance

· Biological influences Rationale The biologically influenced illnesses include schizophrenia, bipolar disorder, major depression, obsessive-compulsive and panic disorders, posttraumatic stress disorder, and autism. Therefore, many (but not all) of the most prevalent and disabling mental disorders have been found to have strong biological influences. Psychological trauma, learned behaviors, and faulty patterns of nurturance may contribute to some forms of mental illness, but they are not major factors in most disabling mental disorders. pp. 17

A distraught 8-year-old child tells the nurse, "I had a horrible nightmare and was so scared. I tried to get in bed with my parents, but they said no. I think I could have gone back to sleep if I had been with them." Which family dynamic is likely the basis of this child's comment? · Boundaries in the family are rigid. · The family has poor differentiation of roles. · The child is enmeshed in part of a family triangle. · Generational boundaries in the family are disuse.

· Boundaries in the family are rigid. Rationale The child's family has rigid boundaries; rules and roles are strictly followed with no room for flexibility, as there would be if the parents allowed the child to sleep in bed with them. The family has clear differentiation of the roles of parent and child. There is no evidence of triangulation, or an unstable relationship between two members of the family with stabilization attempts by the third. Diffuse boundaries are those in which there is blending of roles and a lack of distinction among family members, which is not the case in this situation.

Which theorist believed that the nurse's attitudes of congruence, respect, and empathetic understanding are elective in improving outcomes in clients with psychiatric illnesses? · Jean Piaget · Albert Ellis · Carl Rogers · Albert Bandura

· Carl Rogers Rationale Carl Rogers developed a person-centered model of psychotherapy. He emphasized that attitudes of unconditional positive regard, empathetic understanding, and genuineness are essential for the nurse-client relationship and helpful for improving outcomes in a client. Albert Ellis developed an approach of rational emotive behavioral therapy. He believed in encouraging clients to accept themselves as they are, and that clients should be taught to take risks and try out new behaviors. Jean Piaget identified the stages of cognitive development stage, which are helpful in developing behavioral interventions based on cognitive levels. Albert Bandura developed the concepts of modeling and sell-efficacy. He believed that desired outcomes in a client can be achieved by modifying the client's beliefs or expectation of his or her capacity. p. 24

What is the health care team using when providing certain treatments and interventions within specific time frames to obtain an expected outcome? · Clinical practice guidelines · Clinical judgment · Clinical/critical pathways · Clinical algorithms

· Clinical/critical pathways Rationale Clinical/critical pathways serve as a map for specified treatments and interventions to occur within specific time frames. Each pathway has an expected outcome. Internet resources do not provide this kind of specified guidance. Clinical practice guidelines are systematically developed statements based on literature review that appraise and summarize the best evidence in which to guide clinicians in making informed decisions about specific health problems. Clinical algorithms are step-by-step guidelines prepared in a flowchart or decision tree format. p. 4

A 5-year-old child has this nursing diagnosis: Ineffective coping related to distress regarding the impending divorce of the child's parents as evidenced by disrespectful behavior toward adults and frequent temper tantrums. Which is the best initial outcome for the client within 1 week? · Shows respect for authority figures · Engages in cooperative play with other children · Describes feelings about pending family changes · Identifies which parent he or she wants to live with after the divorce

· Describes feelings about pending family changes Rationale According to Erikson, initiative versus guilt is the psychosocial crisis of this developmental group. The aggression suggests the child fears the conflict and is at risk for a sense of inadequacy or guilt. The first step is for the child to share feelings about the pending family changes; later, outcomes will be targeted more toward the tantrums and disrespect. Although cooperative play with other children is desirable, it does not address the etiology of the child's problem. This child is too young to select a custodial parent. P21

A nurse wants to find a description of the diagnostic criteria for addictive disorders. Which resource should have the most complete information ? · Institute of Medicine (IOM) · North American Nursing Diagnosis Association International (NANDA-I) · Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) · International Classification of Diseases, 9thRevision, Clinical Modification (ICD-9-CM)

· Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) Rationale The DSM-S is published by the American Psychiatric Association and serves as the official guideline for diagnosing psychiatric disorders. It is the dominant mode of understanding mental illness in the United States and the framework for describing psychiatric disorders. The IOM publishes reports regarding national health initiatives and solutions in the United States. NANDA-I details approved nursing diagnoses. The ICD-9-CM is an international standard for diagnostic classification for all diseases. The United States adapted this resource to its system with clinical modification. Test-Taking Tip: Multiple choice questions can be challenging, because students think they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response.

A nurse cares for an elderly retired physician hospitalized with a diagnosis of heart failure. Applying Erikson's ego theory, how should the nurse address this client? · The client's first name · Doctor, followed by the client's surname · Mr., Ms., or Mrs., followed by the client's surname · A familiar and endearing term, such as Dear or Sweetheart

· Doctor, followed by the client's surname Rationale According to Erikson, integrity vs. despair is the psychosocial crisis of this developmental group. Successful completion of this task leads to a sense of integrity and fulfillment. Despite retirement, this client retains the dignity and respect denoted by use of the term "Doctor." Using the client's first name, calling the client Mr., Mrs., or Ms., or calling the client dear or sweetheart disregard the client's identity and like achievements. p. 22

What is the quantitative study of the distribution of mental disorders in human populations called? · Mortality · Prevalence · Epidemiology · Clinical epidemiology

· Epidemiology Rationale Epidemiology is the quantitative study of the distribution of mental disorders in human populations. Mortality refers to deaths. Prevalence refers to the proportion of a population with a mental disorder at a given time. Clinical epidemiology deals with what happens to people with illnesses who are seen by health care providers. p.12

The nurse is working with a client experiencing both postpartum depression and low self-esteem. The client is distrustful of unit staff and "just wants to go home." What is the nurse's priority intervention? · Establish trust with the client. · Teach the client effective mothering skills. · Identify positive traits the client possesses. · Focus on preparing for a speedy discharge.

· Establish trust with the client. Rationale Maslow describes safety as a basic need, meaning that it is so basic to existence that it must be resolved to reduce the tension associated with it. These needs have the greatest strength and must be satisfied before a person turns his or her attention to higher-level needs. Establishing trust will aid in the client's sense of safety. Teaching the client effective mothering skills doesn't address the client's desire to leave and feel safe, so this is not the nurse's priority. Identifying positive traits the client possesses fails to address the client's basic needs first, and so this is not the nurse's priority. Focusing on preparing for discharge fails to address the client's basic and several higher needs and is not the nurse's priority. pp. 23, 24

What should the nurse providing anticipatory guidance to the mother of a toddler advise regarding the handling of childhood temper tantrums? · Giving the child what he or she is asking for · Spanking the child at the onset of the tantrum behaviors · Scolding the child when he or she displays tantrum behaviors · Ignoring the tantrum and giving attention when the child acts appropriately

· Ignoring the tantrum and giving attention when the child acts appropriately Rationale Ignoring the tantrum provides no reinforcement of the undesirable behavior. Instead, approval and reinforcement are given when the child is behaving in the desired way. This is an example of absence of reinforcement, or extinction. Giving the child what he or she is asking for only serves to reinforce the behavior. Scolding or spanking the child will produce negative reinforcement which doesn't necessarily end the behavior, according to the theory. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options. p. 23

What would be the result of the exclusive use of Western psychological theories by nurses making client assessments? · High level of care for all clients · Standardization of nomenclature for psychiatric disorders · Inadequate assessment of clients of diverse cultures · Greater ease in selecting appropriate treatment interventions

· Inadequate assessment of clients of diverse cultures Rationale Unless clients have faith in a particular healing modality, the treatment may not be elective. When nurses make assessments on the basis of Western theories, treatments consistent with those assessments follow. Clients of other cultures may find the treatment modalities unacceptable or not useful. Treatments consistent with the client's cultural beliefs are preferred. Exclusive use of Western theories would not provide a high level of care to all clients. Considering other cultures would not interfere with standard nomenclature of disorders or with selecting appropriate treatment interventions. p.15

According to Maslow's hierarchy of needs theory, when caring for a manic client, which symptom should be given priority? · Lack of sleep · Grandiose thoughts · Hyperactive behavior · Rapid, pressured speech

· Lack of sleep Rationale Based on Maslow's theory, physiological needs such as food, water, air, sleep, etc., are the priorities and must be taken care of first. Rapid, pressured speech, grandiose thoughts, and hyperactive behavior are symptoms of mania, but are not as critical as lack of sleep, so these are not the priorities. p. 23

Maslow's theory of humanistic psychology has provided nursing with a framework for what type of intervention? · Prioritizing nursing care. · Determining moral development · Identifying the potential for success in therapy · Conducting nurse-client interpersonal interactions

· Prioritizing nursing care. Rationale Central to Maslow's theory is the assumption that human beings are active rather than passive participants in like, striving for self-actualization. Maslow focuses on human need fulfillment, which he describes in six incremental stages, beginning with physiological survival needs and culminating in self-transcendent needs. Although these needs are present in all human beings, the behaviors that emanate from them differ according to a person's individual biological makeup and environmental factors. This helps a nurse begin with the base, physical needs and progress. Maslow does not address moral development, the potential for success, or interactions directed toward interpersonal relationships. Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when Your or five consecutive questions have the same letter or number for the correct answer. pp. 24, 28

A nurse working in a psychiatric unit plans to use milieu therapy for a client. Which intervention should the nurse include in the therapy? · Apply current knowledge to assess the client's response to medication. · Coordinate the implementation of the nursing care plan and documents. · Provide and maintain a safe and therapeutic environment in collaboration with others. · Give anticipatory guidance to prevent or reduce mental illness and enhance mental health.

· Provide and maintain a safe and therapeutic environment in collaboration with others. Rationale Milieu therapy means providing and maintaining a safe and therapeutic environment in collaboration with clients, families, and other health care clinicians. Applying current knowledge to assess the client's response to medication pertains to pharmacological, biological, and integrative therapies. Coordinating the implementation of the nursing care plan and documents refers to coordination of care. Giving anticipatory guidance to prevent or reduce mental illness and enhance mental health is related to health teaching and health maintenance. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer.

What is the most appropriate element of nursing to be implemented into a drug addiction program? · Clinical practice guidelines · Attending · Recovery model · Quality and Safety Education for Nurses (QSEN)

· Recovery model Rationale The recovery model is the most appropriate due to the fact that the focus is to primarily manage symptoms, reduce psychosocial disability, and improve role performance. Clinical practice guidelines, attending, and QSEN will inform care offered under the recovery model.

The nursing practice committee has found that several research studies appear to support a change in practice. How is the evidence evaluated to ensure that it warrants a change? · Reviewing it in the context of the hierarchical rating system · Quantifying the number of studies found · Assessing the experience of the researchers · Obtaining the research from CINAHL

· Reviewing it in the context of the hierarchical rating system Rationale Evaluating evidence is done through the hierarchal rating system. The number of studies is relevant, but only in the context of the hierarchal rating system. The experience of the researchers may not be relevant provided the study's methods are sound. CINAHL is one database for research, and other databases may be used.

A newly divorced client assumes all blame for the failure of the marriage and feels incapable of getting involved in a future relationship. According to Freud's psychoanalytic theory, what can the nurse interpret from this behavior? · The client's id, ego, and superego are well-balanced. · The client's id is more powerful than superego and ego. · The client's ego is more dominant than id and superego. · The client's superego is more powerful than ego and id.

· The client's superego is more powerful than ego and id. Rationale The client blames him or herself for the failure of the marriage, which implies that the client is extremely self-critical. The feeling of being incapable of getting involved in a relationship in the future indicates that the client has an inferiority complex. According to Freud's psychoanalytic theory, behavior such as self-criticism and inferiority indicate that the superego is more powerful than the ego and id. In every behavior of an individual, either the id, ego or superego is dominant over the other two. The three personalities are never balanced. If the id is too powerful, the person will lack control over impulses. If the ego dominates over the id and superego, then the client behaves like a mature and well-adjusted individual. p. 20

Consider a 10-year-old child's nursing diagnosis: Delayed growth and development related to insufficient opportunities to interact with other children as evidenced by inability to engage in group play. What is the best outcome for this child's plan of care within the next 2 months? · Voluntarily join a team sport. · Have an improved sense of sell. · Find useful ways to engage in solitary play. · Attend three sessions with a certified child psychologist.

· Voluntarily join a team sport. Rationale Competence versus inferiority: in the school years (ages 6 to 12 years), children's social environment continues to expand as they make new friends and develop new relationships. Children gain new knowledge, learn new skills, and grow more competent. Solitary play, follow-up sessions, and improved sense of self do not relate to the inability to engage in group play. Test-Taking Tip: Key words or phrases in the question stem such as first, primary, early, or best are important. Similarly, words such as only, always, never, and all in the alternatives are frequently evidence of a wrong response. No real absolutes exist in life; however, every rule has its exceptions, so answer with care. p. 26

The nurse implementing trauma-informed care understands that what question defines its main approach? · What is wrong with the client? · What has happened to the client? · Where has the client been? · Why is the client seeking treatment?

· What has happened to the client? Rationale Trauma-informed care provides guidelines for integrating an understanding of how trauma affects client s into clinical programming. A main concept of this approach is a change in paradigm from one that asks "What is wrong with you?" to one that asks, "What has happened to you?" "Where has the client been?" and "Why is the client seeking treatment?" do not define the approach of trauma-informed care.