psychosocial midterms

a home health nurse drives up to the house of her client, who has schizophrenia with manic episodes. the client is sitting on his front porch wit a shotgun in his arms. which of the ff actions should the nurse take? a. honk the horn to get the client's attention b. calmly speak the client's name out of the car window c. keep driving in a path that is going away from the client's house d. stop the car in the client's driveway and call the authorities.

c. keep driving in a path that is going away from the client's house

a nurse is planning care for a group of clients on a mental health unit. which of the ff actions should the nurse plan to take to create a therapeutic environment? a. plan to discuss any topic that is presented b. focus on client weaknesses to increase adaptation c. provide continuity of care by assigning the same staff d. allow the client to determine the boundaries of the nurse-client relationship

c. provide continuity of care by assigning the same staff

a nurse in a mental health facility is preparing to interview a client who has schizophrenia. which of the ff action should the nurse take? a. sit on the other side of the table from the client b. place the client in a chair higher than the nurse c. start the interview with a question the client can answer with a "yes" or "no" d. sit beside the client rather than facing him

c. start the interview with a question the client can answer with a "yes" or "no"

a nurse is caring for a client who has a mental illness. which of the ff actions by the nurse demonstrates ethical concept of autonomy? a. encouraging client feedback about satisfaction with the facility experience b. explaining unit rules and policies regarding unacceptable behaviors c. supporting the client's wish to refuse prescribed medications d. making sure the client understands expectations for client participation

c. supporting the client's wish to refuse prescribed medications

a nurse is caring for a client whose partner is requesting to bring the client food from home that is not allowed in the client's dietary plan. which of the ff responses should the nurse make? a. "why would you want to put your partner's health at further risk?" B. "everyone likes food from home, but it can delay your patient's recovery" c. "you will need to discuss your concerns about your partner's diet with the provider" d. "let's try to find ways to incorporate your partner's favorite food into her diet plan"

B. "everyone likes food from home, but it can delay your patient's recovery"

a nurse si caring for an adolescent client who has a new diagnosis of schizophrenia. the client's parents are tearful and express feelings of guilt. which of the ff statements should the nurse make? a. "you said that you feel guilty about your daughter's diagnosis. let's talk about what is causing you to feel this way" b. "you should not feel guilty about your daughter's diagnosis. schizophrenia is unpreventable" c. "i'm sure your daughter's diagnosis is very difficult to deal with, but everything will be alright once she receives the proper treatment" d. "your provider has explained the causes of schizophrenia. why do you feel guilty about your daughter's diagnosis?"

a. "you said that you feel guilty about your daughter's diagnosis. let's talk about what is causing you to feel this way"

a nurse is caring for a client who has schizophrenia and is experiencing a variety of hallucinations. which of the ff hallucinations is the priority for the nurse to address? a. visual hallucinations b. gustatory hallucinations c. command hallucinations d. tactile hallucinations

c. command hallucinations

a nurse is performing an admission assessment for a client who has schizophrenia. which of the ff findings should the nurse identify as a negative symptom? a. affective flattening b. bizarre behavior c. illogicality d. somatic delusions

a. affective flattening

a nurse is an acute mental health facility is creating a plan of care for a new client who has histrionic personality disorder. which of the ff is the priority intervention for the nurse to make? a. promote appropriate behavior during group therapy sessions b. encourage client input in the treatment plan c. communicate with the client using concrete language d. demonstrate assertive behavior

c. communicate with the client using concrete language

a nurse is assessing a client who has schizophrenia. which of the ff behaviors should the nurse anticipate? a. periods of elation with unusual talkativeness b. preoccupied with folding clothes c. invents words that have no meaning d. recurrent thoughts of past trauma

c. invents words that have no meaning

a nurse in an acute mental health unit is admitting a client who has a bipolar disorder. which of the ff findings supports the admitting diagnosis of acute mania? a. the client's spouse reports that client has recently gained weight b. the client is dressed in all black c. the client responds to questions with disorganized speech d. the client reports that voices are telling him to write a novel.

c. the client responds to questions with disorganized speech

a nurse is teaching a newly licensed nurse about reporting suspected child abuse. which of the ff statements indicates an understanding by the newly licensed nurse? a. "evidence must exist prior to reporting" b. "if the potential abuser commits to stopping the abuse, health care workers are not required to report it" c. i dont want to defame someone if the report is false" d. "if suspicion of abuse exists then reporting is mandatory"

d. "if suspicion of abuse exists then reporting is mandatory"

in supporting patients through periods of illness and change it is helpful for the nurse to (select all that apply) a. review the patient's usual coping style b. identify realistic goals c. identify current priorities and establish meaningful and realistic goals d. tardive dyskinesia

a. review the patient's usual coping style b. identify realistic goals c. identify current priorities and establish meaningful and realistic goals

a school nurse is speaking to the mother of a 16 yr old male adolescent. the mother has concerns about her son. which of the ff statements by the mother should indicate to the nurse that the adolescent is as risk for suicide? a. "his favorite teacher committed suicide a few weeks ago" b. "he has slept 9 hours each night for the past 2 years" c. "he is very religious and attends services twice a week" d. "he spends much of his time with his 2 school friends"

a. "his favorite teacher committed suicide a few weeks ago"

a nurse is caring for an adolescent who is experiencing indications of depression. which of the ff findings should the nurse expect? (select all that apply) a. irritability b. euphoria c. insomnia d. low self-esteem e. chronic pain

a. irritability c. insomnia d. low self-esteem

a nurse is talking with a client who is at risk for suicide ff the death of his spouse. which of the ff statements should the nurse make? a. "i feel very sorry for the loneliness you must be experiencing" b. "suicide is not the appropriate way to cope with loss" c. "losing someone close to you must be very upsetting" d. "i know how difficult it is to lose a love one"

c. "losing someone close to you must be very upsetting"

a nurse is caring for a client who has schizophrenia who consistently does the opposite of what the nurse asks of him. the nurse recognizes this as which of the ff alterations in behavior? a. automatic obedience b. waxy flexibility c. active negativism d. impaired impulse control

c. active negativism

a nurse is discussing legal exceptions to client confidentiality with nursing staff. which of the ff statements by a staff member indicates an understanding of the teaching? a. the legal requirement for client confidentiality ceases if the client is deceased b. staff members are required to divulge information to attorneys if they call for information c. health care workers are not required to answer courts requests for information about a clients disclosure d. providers are required to warn if the client threatens harm

d. providers are required to warn if the client threatens harm

a nurse in an acute mental health facility is communicating with a client. the client states "i cant sleep. i stay up all night." the nurse responds "you are having a difficulty sleeping?" which of the ff therapeutic communication techniques is the nurse demonstrating? a. offering general leads b. summarizing c. focusing d. restating

d. restating

a nurse is caring for a client who attacked one of her friends and is admitted to the psychiatric unit. which of the ff actions should the nurse take first? a. establish a client relationship b. explain to the client that the behavior was unacceptable c. explore the truth of the client's statements d. set behavioral limits for the client

d. set behavioral limits for the client

a nurse is assessing a family as a system. which of the ff factors should the nurse include when assessing sociocultural context? a. the sense of self among individual family members b. the future goals of the family c. the roles of family members d. the family's religious practice

d. the family's religious practice

a nurse in a mental health clinic is conducting a staff education session on schizophrenia. which of the ff manifestations should the nurse identify as negative symptoms? (select all that apply) a. delusions b. hallucinations c. anhedonia d. poor judgment e. blunt effect

a. delusions b. hallucinations c. anhedonia e. blunt effect

in order to integrate care of the mind and body, it is important for nurses to understand the ff. (select all that apply) a. how people react to illness and its effect b. provide holistic nursing c. assess the client for co morbid health conditions d. monitor the client for adverse effects of medications

a. how people react to illness and its effect b. provide holistic nursing

a nurse is caring for a client who has schizophrenia. which of the ff statements by the client indicates concrete thinking? a. i am aware the each problem has only one solution b. "i am a prophet of the most high king" c. the violence tell me that i must avoid large crowds d. i know that you and the other nurse are trying to poison me.

a. i am aware the each problem has only one solution b. "i am a p

a nurse is teaching a newly licensed nurse about appropriate actions to take when a client threatens to harm a specific individual. which of the ff statements by the newly licensed nurse indicates understanding? a. i need to make sure that the potential victim is warned b. i need to keep the information confidential due to the client's right to privacy c. i can only discuss the client's threats with a court order d. i should verbally report this information to the psychiatrist

a. i need to make sure that the potential victim is warned

a nurse is caring for a young adult client who says he is experiencing increased anxiety and an inability to concentrate. which of the ff responses should the nurse make? a. "it sounds like you're having a difficult time" b. "have you talked to your parents about this yet?" c. "why do you think you are so anxious?" d. "how long has this been going on?"

a. "it sounds like you're having a difficult time"

the way we cope with a situation is strongly influenced by a. our appraisal of demands b. how we evaluate our options c. how we respond to problems d. none of the above

a. our appraisal of demands

a nurse is caring for a young adult client who has acute schizophrenic disorder and tells the nurse, "yester noon the sun moon went over the rover to see the lawnmower." which of the ff manifestations is the client exhibiting? a. delusional disorder b. associative looseness c. hallucination d. anhedonia

b. associative looseness

a nurse is caring for a client who has schizophrenia. the client states "the government is forcing thoughts into my brain through satellites." the nurse should document that the client is experiencing which of the ff types of delusions? a. persecution b. control c. eromanic d. somatic

b. control

a nurse is providing teaching about confidentiality with a newly licensed nurse. which of the ff statements by the newly licensed nurse indicates an understanding of the teaching? a. "the court might require me to discuss confidential information" B. "i am required to provide confidential information to insurance companies" c. "if questioned during a police investigation, i am required to divulge confidential information" d. "i am legally allowed to discuss confidential information with the client's former therapist"

a. "the court might require me to discuss confidential information"

a nurse is caring for a client who has dementia. when performing a mental status examination (mse) the nurse should include which of the ff data? (select all that apply) a. ability to perform calculations b. level of consciousness c. recall ability d. long-term memory e. level of orientation

a. ability to perform calculations c. recall ability d. long-term memory e. level of orientation

a nurse is caring for a client who has schizophrenia. the client states that he hears voices telling him to do "bad things". the nurse correctly identifies this finding as which of the ff? a. command hallucinations b. gustatory hallucinations c. cognitive distortion d. somatic delusion

a. command hallucinations

a nurse is performing a psychosocial assessment on an adolescent client. which of the ff should indicate to the nurse a potential risk for suicide? (select all that apply) a. death of a parent at a young age b. recent or impending move c. low parental expectations d. volunteering at a community center after school e. sudden decline in school performance

a. death of a parent at a young age b. recent or impending move c. low parental expectations e. sudden decline in school performance

a nurse is communicating with a client who has just admitted for her treatment of substance use disorder. which of the ff communication techniques should the nurse identify as a barrier to therapeutic communication? a. offering advice b. reflecting c. listening attentively d. giving information

a. offering advice

coping can be characterized as (select all that apply) a. problem-focused coping b. emotion-focused coping c. meaning-based coping d. inability to cope

a. problem-focused coping b. emotion-focused coping c. meaning-based coping

a nurse notices that a client who has moderate anxiety is pacing the hall and mumbling. as the nurse approaches the client, he states, "i am at the end of my rope. i dont think i can take any more bad news." which of the ff responses should the nurse make? a. "most clients with anxiety issues benefit from lying down" b. "come with me to an area where we can talk without interruption" c. "providers usually recommend relaxation exercises for clients who are as upset as you are" d. "an antianxiety pill works best for situations like this"

b. "come with me to an area where we can talk without interruption"

a nurse is caring for an adolescent who has a history of violent behavior and has asked the nurse to keep confidential information about the desire to kill several classmates and a school teacher. which of the ff responses by the nurse is appropriate to give? a. "because you are a minor, i have to share any information that i feel is important with your parents" b. "i cannot promise that. i must share this information with other members of the team who are responsible for planning your care" c. "i will not violent our nurse-client relationship. the information we discuss will remain confidential between us" d. "i can see that you trust me, but you should share those feelings with your psychiatrist, not me"

b. "i cannot promise that. i must share this information with other members of the team who are responsible for planning your care"

a nurse is caring for a client who smokes and has lung cancer. the client reports "im coughing because i have that cold that everyone has been getting." the nurse identify that the client is using which of the ff defense mechanism? a. reaction formation b. denial c. displacement d. sublimation

b. denial

a nurse is caring for a client who is experiencing a crisis related to anxiety. which of the ff actions should the nurse take? (select all that apply) a. avoid eye contact to prevent escalation of anxiety b. establish rapport with the client c. identify the cause of the anxiety d. validate the client's feeling e. develop a flexible crisis intervention plan.

b. establish rapport with the client c. identify the cause of the anxiety d. validate the client's feeling

a nurse decides to put client who has a psychotic disorder in seclusion overnight because the unit is very short-staffed, and the client frequently fights with other clients. the nurse's actions are an example of which of the ff torts? a. invasion of privacy b. false imprisonment c. assault d. battery

b. false imprisonment

a nurse is caring for a client who has schizophrenia. which of the ff statements by the client indicates understanding of a relapse intervention plan? a. i can remember when my hallucinations first began b. i know which of my hallucinations trigger a relapse c. i record the number of hallucinations i have each day d. i will read as much information as i can about schizophrenia.

b. i know which of my hallucinations trigger a relapse

a nurse is developing a plan of care for a newly admitted client who has schizophrenia and experiences frequent hallucinations and paranoid delusions. which of the ff actions should the nurse plan to take? a. place the client in seclusion if visual hallucinations are present b. limit the number of questions asked during assessments c. use frequent touch to provide client support d. directly tell the client that delusions are not real

b. limit the number of questions asked during assessments

a nurse hears a newly licensed nurse discussing a client's hallucination in the hallway with another nurse. which of the ff actions should the nurse take first? a. notify the nurse manager b. tell the nurse to stop discussing the behavior c. provide an in-service program about confidentiality d. complete an incident report.

b. tell the nurse to stop discussing the behavior

a nurse in a mental health facility is interacting with a client who is angry and becoming increasingly aggressive. which of the ff actions should the nurse take? a. move the client to a private area so the conversation will not be disturbed b. use clarification to determine what the client is feeling c. speak to the client using an authoritative voice d. maintain constant eye contact with the client

b. use clarification to determine what the client is feeling

a nurse is caring for a group of clients in an acute mental health facility. which of the ff clients has the legal right to refuse treatment? a. a 16 yr old client whose parents have requested treatment b. an adult client who has delusions and refuses treatment for religious reasons c. an older adult client who was voluntary admitted d. a client who is competent but was involuntary admitted

c. an older adult client who was voluntary admitted

a nurse is caring for a client who has schizophrenia and is experiencing a hallucination. which of the ff actions should the nurse take? a. act to the client as if the hallucination is real b. instruct the client to argue with the voices that are a part of the hallucination c. ask the client direct questions about the hallucinations d. tell the client that the hallucinations is not a part of reality.

c. ask the client direct questions about the hallucinations

mind, body, and nursing can be describe using the ff terms a. dualism b. holism c. integration d. all of the above

d. all of the above

a nurse is conducting a group therapy meeting and is sharing a humorous story. when the group laughs at the story, a client who has schizophrenia jumps up and runs out while yelling, "you are all making fun of me." which of the ff behaviors is this client displaying? a. grandeur b. flight of ideas c. erotomania d. ideas of reference

d. ideas of reference

a charge nurse is conducting a class on therapeutic communication to a group of newly licensed nurses. which of the ff aspects of communication should the nurse identify as component of verbal communication? a. personal space b. posture c. eye contact d. intonation

d. intonation