psych test 1: ch. 1,5,6

deinstitutionalization has reduced the number of public hospital beds by what percentage?

80%

what is a result of deinstitutionalization?

A "revolving door" of repetitive hospital admissions

which is a clinical activity of only the advanced practice registered nurse?

psychotherapy

When considering the zones of distance awareness, the nurse expects that initially the client who exhibits paranoia will be most comfortable interacting within which zone of proximity with the nurse?

public

A client tells the nurse, "I had to slap my child, I couldn't help that." Which response of the nurse indicates that the nurse is in the state of unknowing?

what was going on for you when this happened

The therapeutic communication interaction is most comfortable when the nurse and the client are how far apart?

3-6ft

Which statement would indicate that the nurse has a non-judgmental attitude?

"The client has struggled with her life circumstance of living with a man who beats her, and she is trying very hard to make the changes necessary to help herself."

Approx. what percentage of homeless people suffer from a severe psychiatric illness of a chronic substance use disorder?

42%

assertiveness

-the ability to express positive and negative ideas and feelings in an open, honest, and direct way -works best when the speaker is calm, makes specific, factual statements, and focuses on "I" statements -recognizes the rights of both parties

words to eliminate

-why -just -honestly -but -should -i dont know -you know -just saying -actually -im sorry -like -i mean

the substance abuse and mental health services estimates that more than what percentage of americans aged 18 years or older has a diagnosable mental disorder?

18.6%

what percentage of adults requiring mental health services get the care they need?

25%

when reviewing the evolution of mental health care in the US, a psychiatric-mental health nurse reads about the creation of state hospitals for mental health care. the nurse would attribute this concept of care as the idea supported by:

Dorothea Dix

when providing care to a client, the psychiatric-mental health nurse is implementing the therapeutic use of self. the nurse is applying the concepts based on the work of which individual

Hildegard Peplau

maintaining a therapeutic environment and promoting growth through role modeling are components of which basic level function?

Milieu therapy

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

Peplau

A nurse is conducting a 6-week social skills training program. A young adult with schizophrenia asks the nurse to call the client on the weekends so the client has someone to talk to who really cares. Which action should the nurse take?

Remind the client about the importance of boundaries to keep the relationship therapeutic

A client is speaking to the nurse and expressing dissatisfaction about the care that was provided to the client during a hospital stay. The nurse tells the client, "This is the best hospital in the state. You could not expect better care anywhere else." Which type of communication does this indicate?

defending

in early christian times what was the thought to cause of mental illness?

demonic control

The psychiatric nurse recognizes that excessive social communication with a client is to be avoided primarily due to which reason?

To prevent the client from viewing the nurse as a friend rather than health care provider

Which clinical situation provides an example of transference?

a female client with a history of sexual abuse exhibits a profound mistrust of male caregivers

In the 1970s, state mental hospitals came under increasing scrutiny and many were closed. What was the end result of this trend?

a lack of suitable housing for a persons with mental illness

in the 1970s, state mental hospitals came under increasing scrutiny and many were closed, what was the end result of this trend?

a lack of suitable housing for persons with mental illness

which individual has experienced the consequences of deinstitutionalization?

a woman who was transferred from a psychiatric hospital to the community because of the hospital's impending closure

Which form of messaging contain figures of speech that are difficult to interpret and can be a barrier to communication?

abstract

During the orientation phase of a nurse-client relationship, the nurse notes a change in the client's behavior. The client has forgotten a scheduled session and then accuses the nurse of breaking confidentiality. The nurse interprets this as suggesting what?

acting out

The nurse knows the written instructions for healthcare when a person is incapacitated is called:

advance directive

Which role of the nurse-client relationship is being exhibited when the nurse informs the client and then supports the client in whatever decision the client makes?

advocate

chlorpromazine is a drug in which class?

antipsychotic

A client with depression has been admitted to the mental health unit and is attending group therapy sessions as part of the treatment. The client asks the nurse leading the group if the nurse is married or has a girlfriend. The nurse responds, "I am curious what made you ask this question; however, what is important is how you are feeling today." The nurse's response is what?

appropriate, because the focus of the therapeutic relationship is the client, not the nurse

The nurse is using a directive role when asking a client which question?

are you thinking about hurting someone else right now

A client expresses to the nurse that the client has been unable to sleep due to work. The nurse asks the client, "Do you mean that the work in the office is causing stress, which is why you are not able to sleep?" Which type of therapeutic communication technique is this conversation indicative of?

consensual validation

Which includes the circumstances or parts that clarify the meaning of the content of the message?

context

Which type of cue is being used when the client states, "Nothing can help me"?

covert

Which term is used to refer to signals that encourage effective communication?

cues

Which is not considered a step in the values clarification process?

assessing

a nurse is reading a journal article about practices involved during the moral treatment movement in psychiatric-mental health care. which practice is most likely to be included as being used during this time?

asylums

The nurse is assessing a client who was recently diagnosed with anxiety disorder. Which question asked by the nurse conveys a concrete message?

at what time did you take the last dose of the antianxiety drugs

When discussing institutionalization which issue would most likely be considered a major problem associated with large state institutions?

attendants were accused of torturing female clients clients were isolated from family and community clients were not given proper nutrition or clothed properly

A nurse engaged in an interaction with a client recognizes body space zones. Which would the nurse identify as the individual's personal zone?

beginning at the boundary of the intimate zone and ending at the social zone

Which therapeutic communication technique is being utilized when the nurse asks the client, "Is there something you'd like to talk about?"

broad openings

Which statement by the nurse demonstrates an understanding of the first step in helping a client learn the problem solving process?

can you explain to me what made you so angry?

in early christian period, who treated clients thought to be possessed by demons causing their mental illness?

clergymen

A client tells the mental health nurse that the client is taking a sewing class to cope with the client's son's move to another state. The use of this adaptive coping skill is an example of which aspect in the therapeutic relationship?

client self-exploration

A psychiatric-mental health nurse is working with several clients and decides to use silence during the interaction. In which situation would it be therapeutically appropriate to use silence? Select all that apply.

client who is experiencing depression client who is constructing a response client who is pondering the question client who is lost in own thoughts

A nurse is conducting an initial assessment of a client. When the client enters the nurse's office, the client finds the nurse sitting with arms folded across the chest and an emotionless facial expression. The nurse is exhibiting which nonverbal communication technique?

closed body position and impassive face

The psychiatric mental health nurse is planning the care of a client. what action best addresses the client's needs in the social domain?

collaborating with the client's family to organize support

a psychiatric-mental health nurse is describing the various programs offered by the local community mental health center. when explaining how these programs work, the nurse would emphasize which concept?

collaboration

the nurse has been unsuccessful in the psychiatric clinical placement and will be obliged to repeat it next semester. the criteria for passing or failing were based on the psychiatric-mental health nursing scope and standards of practice, which are?

descriptions of the responsibilities for which nurses are accountable

After teaching a class about the phases of the therapeutic relationship, the instructor determines a need for additional education when the class identifies which as a goal of the working phase?

develop a sense of trust within the relationship

The manager is reviewing the implementation of the Transitional Relationship Model (TRM) on a care area. Which data should the manager identify that supports the successful implementation of this model? Select all that apply.

discharge of clients 5 days earlier than in the past number of readmissions down 6% over the last 2 months

the nurse recognizes that public education is needed to erode stigma to prevent what?

discrimination

A group of nursing students is role playing situations to practice using therapeutic communication techniques. What would the students identify as verbal communication?

emotion underlying the words

Which verbal cue refers to accents on words or phrases that highlight the subject or give insight on the topic?

emphasis

When comparing social interactions with therapeutic interactions, the nurse understands that therapeutic interactions do what?

encourage personal goal setting

What is the primary benefit of the DSM-5 to the student nurse's practice with the mentally ill population?

encourages the building of a knowledge base about the natures of psychiatric illness

A nurse is engaged in a therapeutic relationship with a client. What should the nurse do in order to ensure therapeutic communication takes place? Select all that apply.

ensure the client's confidentiality employ theoretically based interventions focus on the client during the interaction

The nurse prepares to assess a client for the first time. Which action should the nurse take to develop a rapport with this client? Select all that apply.

establish professional boundaries listen intently to the client explain problems and issues explain what confidential information will be shared with others

one of the primary reforms accomplished by Dorothea Dix was the

establishment or enlargement of state hospitals

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

evaluating the effectiveness of psychiatric medications

A nursing student is caring for a client who has been arrested for child abuse. The nurse is very curious about what the client must have done to get into so much trouble, so the nurse asks the client to tell the nurse about the various activities that got the client arrested. This is an example of:

excessive probing

the nurse is engaging in assertive communication when which communication approach is used?

expressing feelings attaches to the concern using "I" statements using direct language

Which is not involved in empathy?

feelings the same emotions that the client is feeling at a given time

in terms of causing disability among people ages 15-44 years of age in north america, where does mental illness rank?

first

which is the difference between counseling and psychotherapy?

generalist psychiatric nurses may perform counseling interventions, but psychotherapy is an advanced practice role

The nurse is teaching effective anger management. The nurse emphasizes the use of assertive sentences while expressing anger. Which are examples of assertive communication? Select all that apply.

i am frustrated with the situation i am feeling disrespected by your comments

A psychiatric-mental health client tells the nurse, "The doctor hates me. The doctor promised to try to come and check on me after dinner yesterday but never came." What is the nurse's most therapeutic response?

i dont know why the doctor didnt come, but i can assure you that its not because she hates you

A nurse is engaging in an interpersonal interaction with a young adult client who is admitted to the hospital with suicidal ideation. The client states, "I am really not good at anything." How should the nurse respond to the client's statement?

i have a really difficult time believing that

A client explains feelings of sadness and loss after the death of a close friend. Which nursing statement best demonstrates empathy?

i see this is hard for you. how can i help?

Which statement by the nurse is an example of assertive communication?

i understand that group can be difficult to attend but coming late is disruptive

A psychiatric-mental health nurse has been off of work for the past 4 days, as per the normal work schedule on the unit. On the nurse's first day back, a longterm client says, "I haven't seen you around here since Thursday. How was your time off?" What is the nurse's most appropriate response?

i've been off for the past four days. what have you done since i last saw you?

The client tells the nurse, "My mom is coming in to see me today," while sighing and looking out the window. The nurse states, "You don't seem very excited about the visit, is everything OK?" The client affirms. Using therapeutic communication, how should the nurse respond?

im concerned that you are not excited about your mother's visit, we can talk if you want

which provides the best definition of mental illness?

inability to function in a manner that manages both external and internal stressors effectively

Which is the most influencing factor that complicated the treatment of people with mental illness in the US?

insurers' reimbursement decisions

What are the standards of professional performance that a nurse should implement when caring for a mentally ill client? Select all that apply.

integration of research collegial interaction collaboration with clients and their families

The nurse and client are discussing discharge plans. Which statement should the nurse make that demonstrates empathy for the client's fear of returning to a group home environment?

it can be scary to leave a place that you trust and feel supported

Which is an inaccurate statement regarding a preconception?

it enables the nurse to get an accurate picture of the client's problems

which is an accurate depiction of self-awareness?

it involves changing one's values or beliefs

A client diagnosed with schizophrenia has recently become divorced and is living in public housing. How would the DSM-5 best help in planning this client's care?

it is used by the mental health team to id the psychosocial and environmental factors currently affecting the client

A client says, "Nobody listens to me; even you don't!" Which response is most therapeutic?

it sounds like you're feeling unappreciated

Until the onset of the Renaissance, the general population held which belief regarding the presence of sickness?

it was punishment for sins and wrongdoing

A client from which cultural background would most likely have an older family member present when discussing health issues with the nurse?

korean

medical insurance coverage for medical illness is greater than for psychiatric illness. what term best describes this discrepancy?

lack of parity

The nurse is caring for a client with cellulitis. The client responds, "I feel kind of 'blah'," after the nurse asks, "How do you feel?" After the client's reply, the nurse states, "Can you tell me what 'blah' feels like?" The client responds, "I don't have any energy, and I don't feel like doing anything." Using therapeutic communication, how should the nurse respond?

let's talk about infections, and how they heal

a nurse is reviewing the historical trends impacting the practice of psychiatric-mental health nursing practice. the nurse demonstrate understanding of the information by identifying which individual as being resonsible for opening the first training school for nurses in 1882?

linda richards

A client refuses to interact with a student nurse during a clinical session. which would be the most helpful in the immediate situation? select all that apply

listen to the client show genuine interest in the client's situation

a nurse is providing community education about the prevention of mental illness. in response to the the question "what does it mean to be mentally healthy?" which is the nurse's best response?

mental health is marked by productivity, fulfilling relationships, and adaptability

Which federal law prevents insurance companies form enforcing annual or lifetime dollar amounts to be paid for mental health care?

mental health parity act

A nurse is conducting a review class for a group of psychiatric-mental health nurses about the changes in psychiatric care that have occurred through the years related to legislation and policy initiatives. The nurse determines that the teaching was successful when the group identifies that supporters of the Community Mental Health Centers Construction Act (1963) believed that institutionalization was contributing to what?

mental illness

During the 1800s, Pinel believed that the cure for mental illness was ...

moral treatment

A client on the psychiatric mental health unit has a care plan that includes a break for cigarettes every hour during the afternoon if the client follows the behavioral plan to attend the morning group on anger management. The client asks, "I couldn't get to my group this morning because I overslept. Can I just this one time go for a cigarette now?" Which response by the nurse is most therapeutic?

no, joe. your plan says that you need to attend that group in order to have cigarette breaks

The nurse is reviewing the client's history, identifies themes, and considers how the nurse can be most therapeutic to a client who was recently admitted to a psychiatric unit. The nurse is functioning in which phase of the therapeutic relationship?

orientation

A nurse is caring for a client on an inpatient mental health unit of a hospital. The nurse tells the client, "You are scheduled to attend therapy sessions every morning at 9:00 a.m. Please make sure that you complete your morning routine, such as using the restroom, bathing, and eating breakfast, before you come for the sessions." Which phase of the nurse-client relationship does this communication indicate, according to the Peplau's model?

orientation phase

who was the first to introduce the concept of interpersonal relations and the therapeutic relationship?

peplau

A nurse is in the orientation phase of the nurse-client relationship with a client diagnosed with a mental disorder. When interviewing the client during this first encounter, which information about the client would be most important for the nurse to obtain?

perception of the problem

A nurse responds to a client's statement with silence based on the rationale that this technique is used primarily to:

permit the client to gather their thoughts

A client diagnosed with schizophrenia is hallucinating. Which communication technique may the nurse use to redirect the client?

presenting reality

When providing information about anorexia to a client, the nurse can ensure that the client can accurately comprehend the information by doing what?

presenting the information using language and terms the client will understand

The nurse is caring for a client recently diagnosed with a psychiatric illness. Which key areas should the nurse focus on while caring for this client? Select all that apply.

preventing deterioration of mental status promoting mental health promoting physical health

During a therapy session, the nurse asks the client, "Tell me more about your relationship with your parents." The nurse is using which therapeutic communication technique?

probing

which intervention is appropriate for a psychiatric-mental health nurse at the basic level of practice?

promoting symptom management

during the mid-20th century, the focus of treatment centered on treating neurotransmitter dysfunction in the brain. as a result hospital stays were shortened due to the introduction of which?

psychopharmacology

what nursing action demonstrates the intended impact of the American Nurse Association standards of care on mental health nursing care?

referring to the standards to determine if a particular prescribed treatment falls within the scope of a nurse's practice

a client demonstrates sexually inappropriate behavior toward a student. what is an effective way for the student to respond while protecting and respecting the client?

report the incident to staff and the clinical instructor so boundaries can be reenforced with the client

what is a criterion for mental health?

satisfaction with personal relationships and self

A client is engaged in the orientation phase of the nurse-client relationship. The client should be involved in which activity?

seeking assistance

A nurse has been in a therapeutic relationship with a client for several weeks. When the client comes in for the weekly appointment, the nurse touches the client's arm when saying hello. The nurse has used which form of touch?

social-polite

The nurse is talking with a married client just diagnosed with syphilis. The nurse talks with the client about disclosing the information to the spouse and/or any other sexual partners. The client cries and asks the nurse, "Have you ever had an affair?" The nurse states, "Yes, it usually doesn't turn out well." The nurse proceeds to answer other questions about the affair. By answering these personal questions the nurse is divulging what?

self-disclosure

The nurse is talking with the client about lowering cholesterol and raising high density lipoproteins (HDLs). The nurse states, "Niacin with applesauce helps to prevent the flushing sensation that often accompanies taking this drug." What is the nurse providing with this statement?

self-disclosure

A client relates that the client has panic attacks and, during the attacks, rushes to the emergency department because the client feels like the client is dying. The nurse discloses that the nurse has had panic attacks during which the nurse also felt very fearful. Which statement represents an accurate statement about this self-disclosure?

self-disclosure can help normalize the client's experience

A hospitalized client diagnosed with depression asks a nurse, "Should I go home this weekend?" Which response by the nurse uses the technique of reflection?

should you go home for the weekend?

A psychiatric-mental health nurse is working on a committee that is developing programs that integrate the objectives for mental health and mental disorders, as id by Healthy people 2020. which type of program would be least apporpriate?

single substance abuse treatment programs

Which arrangement is likely to be the least threatening to a psychiatric-mental health client?

sitting at an angle, 4-5 feet apart

A nurse reviews a client's psychiatric and medical history before approaching the client for an assessment. The history reveals the client has a history of sexual abuse from a caregiver in early adolescence. Which zone would be the best place for the nurse to sit the nurse to begin the assessment?

social

Which type of touch, according to Knapp, is used in greeting, such as a handshake?

social-polite

Dorothea Dix's solution to gain humane treatment for the mentally ill population included what?

state hospitals

A client with mental illness has come to an outpatient mental health clinical for a counseling session with the community mental health nurse. Which areas should be the focus of counseling for this client? Select all that apply.

stress management behavior modification communication skills

A client expresses frustration and believes the nurse does not want to help the client achieve wellness. Which phase of the deteriorating relationship is the client describing?

struggling with

A nurse is caring for a client with posttraumatic stress disorder. Which behavior of the client indicates the resolution phase?

the client is able to independently express feelings and emotions with the client's friends

A nurse is meeting a client for the first time. The nurse observes that the client smiles appropriately but is using rambling speech while answering the nurse's questions. Which would most likely be the reason for this behavior?

the client is nervous and insecure

A psychiatric-mental health nurse has entered a client's room, made an introduction, and asked if the nurse and the client could speak for a few minutes. The clients states, "Yep. Glad to talk." However, the nurse observes that the client is looking at the floor and the client's arms and legs are crossed. How should the nurse best interpret this situation?

the client may be reluctant to dialogue despite the statement to the contrary

The nurse is sitting behind a table while speaking to a client on the other side of the table. What is the most appropriate reason for this nurse's action?

the client may have difficulty maintaining spacial boundaries

The nurse is caring for a client with severe depression. The client tells the nurse, "I really just want to sleep and not have to wake up." What may the nurse interpret from this covert cue?

the client may have suicidal ideations

Which would indicate that the nurse-client relationship has passed from the orienting phase to the working phase?

the client recognizes feelings of anger and expresses them appropriately

A nurse is assessing an adolescent client who has recently been self-mutilating. The nurse asks the client questions that seek to uncover the motivation underlying the behavior. The nurse's approach best reflects what?

the exploration of behaviors to uncover the client perspective

Which is necessary as a defining feature in mental illness?

the individual must have difficulties in functioning that cause distress and/or impairment of some type

A client expresses worry about the client's child's aggressive behavior. The nurse says "You are in a very challenging situation. Your child's aggressive behavior is very stressful for you, is this correct?" What does this nurse's statement indicate?

the nurse is empathizing with the client

The nurse is speaking with a client. The nurse sits with legs crossed and arms folded across the chest while listening to the client. How might the client interpret this posture of the nurse? Choose the best answer.

the nurse may be showing nonacceptance toward the client

A client reveals in a therapy session that the client has thought about killing a neighbor. What is the therapist's obligation regarding this revelation?

the therapist must notify the authorities and the potential victim

Which is a nurse's primary tool for treating clients with mental disorders?

therapeutic use of self

A nurse has approached a new client on the psychiatric care unit in order to establish a therapeutic relationship and conduct a focused assessment. As the nurse approaches the client, the client says, "Oh good. Here comes one more person to tell me that I'm crazy." Which of the nurse's following responses would constitute countertransference?

there's no need to get rude with me. im just trying to do my job and help you.

Which is an inaccurate depiction of concrete messaging?

they require rephrasing of unclear messages

The graduate nurse is working in mental health and is learning about the use of touch with clients that have psychiatric disorders. The seasoned mental health care nurse differentiates information about this part of therapeutic communication by stating which information?

touch carries different meanings for different individuals

A nurse notices that a neighbor has been admitted to an inpatient psychiatric unit. The nurse understands that the nurse may not discuss this with any of the nurse's family or neighbors, because doing so would breach the client's confidentiality. Confidentiality is a component of which element of the therapeutic relationship?

trust

The nurse is caring for a client that is very confused. What intervention should be included with the nurses' non-communication with the client?

use of gentle touch during activities of daily living

A psychiatric-mental health nurse is preparing a presentation about the historical evolution of current psychiatric-mental health treatment. When describing the impact of Sigmund Freud's work on care, which information would the nurse most likely include? Select all that apply

use of psychoanalysis to address the underlying injury a disturbance in personality development as an underlying issue

A nurse is caring for a client with hemiplegia who has been depressed. The client tells the nurse, "I don't feel I would ever be independent again. I would be a burden to everybody in my house." The nurse responds by stating, "Your family misses you a lot and wants you home as soon as possible. The rehab team is very confident about your progress." Which phase of nurse-client relationship is occurring?

working

The nurse therapist calls a client to reschedule their appointment for the following week. When the client arrives at the appointment, the client is uncommunicative and avoids eye contact with the nurse. When asked how things have been going, the client answers, "Fine." How should the nurse confront this behavior?

you appear to be angry. perhaps you are angry with me for rescheduling our appointment or something else has happened. tell me more about what you are feeling

which statement by the nurse reflects the use of a therapeutic statement?

you look upset. would you like to talk about it?

A nurse is speaking to a client with a soft smile and eye contact. Which statement said by the nurse would indicate a congruent message?

your hard work and determination had helped you recover

A client arrives for a scheduled meeting with the nurse. Which statement should the nurse make that indicates the working phase of the relationship?

your idea would help prevent this from happening again