Test 1 and 2

Which statement by a patient who has been taught cognitive reframing indicates that the teaching was successful? "I do not have the ability to handle that job" "I can be successful if I do all the things required to learn the job" "I may be fired from the job but eventually I will find something else to do with my life" "I can never learn all there is to know for the job"

"I can be successful if I do all the things required to learn the job." Cognitive reframing changes the individual's perceptions of stress by reassessing a situation and replacing irrational beliefs with more positive self-statements. The other options are all negative cognitive distortions that would prevent the individual from success.

Which question is focused on the assessment of an individual's personal ability to manage stress? select all that apply "Have you ever been diagnosed with cancer?" "Do you engage in any hobbies now that you have retired?" "Have you been taking your antihypertensive medication as it is prescribed?" "Who can you rely on if you need help after you're discharged from the hospital?" "What do you do to help manage the demands of parenting a 4-year-old and a newborn?"

"Do you engage in any hobbies now that you have retired?" "Who can you rely on if you need help after you're discharged from the hospital?" "What do you do to help manage the demands of parenting a 4-year-old and a newborn?"

Which assessment question focuses on determining the resilience of a preteen child? Select all that apply. "Do you like playing video games?" "How do you and your friends have fun?" "How are you adjusting to your new school?" "What would you do if you forgot your homework?" "What job would you like when you grow up?"

"How do you and your friends have fun?" "How are you adjusting to your new school?" "What would you do if you forgot your homework?" "What job would you like when you grow up?"

What assessment question is focused on identifying a long-term consequence of chronic stress on physical health? "Do you have any problems with sleeping well?" "How many infections have you experienced in the last 6 months?" "How much moderate exercise do you engage in on a regular basis?" "What management techniques do you regularly use to manage your stress?"

"How many infections have you experienced in the last 6 months?"

Hugo has a fraternal twin named Franco who is unaffected by mental illness even though they were raised in the same dysfunctional household. Franco asks the nurse, "Why Hugo and not me?" The nurse replies: "Your father was probably less abusive to you" "Hugo likely has a genetic vulnerability" "You probably ignored the situation" "Hugo responded to perceived threats by focusing on an internal world"

"Hugo likely has a genetic vulnerability"

A client is brought to the hospital by her daughter, who visited this morning and found her mother to be confused and disoriented. When the client is admitted, the daughter states, "I'll take her glasses and hearing aid home, so they don't get lost." The best reply for the nurse would be "That will be fine. I'll have you sign our hospital release form." "Because we do not have a copy of durable power of attorney, we cannot release them to you." "Don't worry. You can leave them at her bedside. We are insured for losses of this sort." "I would like to have your mother wear them. It will help her to be less confused."

"I would like to have your mother wear them. It will help her to be less confused." Clients with cognitive disorders usually profit from being able to see and hear clearly. Confusion is reduced through the use of glasses and hearing aids.REF: Page 433

The nurse teaches a patient with anxiety about stress and triggers. Which statement made by the patient indicates the teaching was effective? "Stress is a negative response." "Eustress is resistance to stress." "People can have good and bad stress." "People with stress are always in distress."

"People can have good and bad stress."

A patient admitted with anxiety asks, "What exactly are stressors?" What is the nurse's best response to the patient's question? "Stressors are events that happen that threaten your current functioning and require you to adapt." "Stressors are complicated neuro stimuli that cause mental illness." "It's best if you ask questions like that of your provider for a complete answer." "Instead of focusing on what stressors are, let's explore your coping skills."

"Stressors are events that happen that threaten your current functioning and require you to adapt." Stressors are psychological or physical stimuli that are incompatible with current functioning and require adaptation. Stressors are not complicated neuro stimuli; telling the patient to address these questions to her provider fails to educate the patient, which is the nurse's responsibility. Exploring coping skills would be a good intervention at a later time but does not address the patient's question and changes the subject.

During a home visit, the nurse finds that an adolescent is upset after failing a midterm exam at school. What positive statement does the nurse use to comfort the adolescent? "Do you feel like you should have studied more?" "You should not be upset for such a small reason." "This probably just isn't your best subject, and you should focus on your stronger subjects." "You can learn from this experience and refocus your attention to improve your future performance."

"You can learn from this experience and refocus your attention to improve your future performance."

A cognitive therapist would help a client restructure the thought "I am stupid!" to...

-- "What I did was stupid."

According to Freud, the nurse recognizes that a client experiencing dysfunction of the conscious as part of the mind will have problems with...

-- all material that the person is aware of at any one time

A patient's family member brings in a list of medications the patient is taking for Alzheimer disease. The patient has begun experiencing psychotic symptoms as well as dementia. Medication from which class will likely be discontinued? 1. Antipsychotics 2. Anticonvulsants 3. Antidepressants 4. Antianxiety agents

1. Antipsychotics When administered to patients with dementia, antipsychotics can cause psychotic side effects. Antidepressants, antianxiety agents, and anticonvulsants can be used in various combinations without causing psychotic symptoms.

Which question should be asked when considering the evaluation of outcomes for a patient experiencing cognitive dysfunction? Select all that apply. 1. Are the stated outcomes measureable? 2. Are the patient's cognitive skills deteriorating? 3. Is the patient capable of achieving the outcomes? 4. Are the caregivers capable of creating outcomes? 5. When were the patient's outcomes last evaluated?

1. Are the stated outcomes measureable? 2. Are the patient's cognitive skills deteriorating? 3. Is the patient capable of achieving the outcomes? 5. When were the patient's outcomes last evaluated?

A patient diagnosed with delirium strikes out physically at a staff member. What is the most likely cause of this behavior? 1. State of fear 2. Physical illness 3. An unmet physical need 4. The need for social interaction

1. State of fear Patients with delirium often misinterpret reality, perceiving threat where none actually exists. Delirious patients who are fearful may strike out at others, seemingly without provocation. Physical illness, an unmet physical need, or the need for social interaction generally are not associated with such aggressive behavior.

Which medication is aimed at preventing the breakdown of acetylcholine? Select all that apply. 1. Tacrine 2. Donepezil 3. Rivastigmine 4. Memantine 5. Galantamine

1. Tacrine 2. Donepezil 3. Rivastigmine 5. Galantamine Because a deficiency of acetylcholine has been linked to Alzheimer's disease, medications aimed at preventing its breakdown (cholinesterase inhibitors) have been developed, including tacrine hydrochloride, donepezil, rivastigmine, and galantamine. Memantine normalizes levels of glutamate, a neurotransmitter that may contribute to neurodegeneration.

Which practice demonstrates a proactive approach to minimizing the stress commonly experienced by nursing staff caring for the cognitively impaired patient? Select all that apply. 1. Realistic patient outcomes 2. Mandatory transfers off of units 3. Small nurse-to-patient care ratios 4. Thorough understanding of the disorder 5. Reasonable expectations of patient abilities

1. Realistic patient outcomes 4. Thorough understanding of the disorder 5. Reasonable expectations of patient abilities Because stress is a common occurrence when working with persons with cognitive impairments, nurses need to be proactive in minimizing its effects, which can be facilitated by having an understanding of the disease and realistic expectations. Small nurse-to-patient care ratios and mandatory transfers off of units are not realistic and are unnecessary when staff is informed and well supported in their caregiving.

A 75-year-old patient is hospitalized with sudden onset confusion and disorientation. The patient wanders and becomes agitated without any apparent stimulus. What is the highest priority nursing diagnosis? 1. Risk for injury 2. Acute confusion 3. Impaired memory 4. Self-care deficit, bathing, or hygiene

1. Risk for injury Risk for injury; acute confusion; impaired memory; and self-care deficit, bathing, or hygiene are diagnoses likely to apply in this situation; however, safety is the nurse's highest priority.

Which behavior is associated with typical age-related cognitive changes? Select all that apply. 1. Taking 30 minutes to find one's misplaced car keys. 2. Having the electricity turned off for lack of payment. 3. Experiencing difficulty recalling a synonym for happy. 4. Forgetting the address of the first apartment you rented. 5. Failing to pay the credit card bill while away on vacation.

1. Taking 30 minutes to find one's misplaced car keys. 3. Experiencing difficulty recalling a synonym for happy. 4. Forgetting the address of the first apartment you rented. 5. Failing to pay the credit card bill while away on vacation. Typical age-related cognitive changes include occasional examples of memory lapse, poor judgment, and omissions. The more serious, atypical changes involve complete, constant, or chronic issues with memory and cognition.

A nurse was assigned to select patients with Alzheimer's disease for a clinical trial of a new drug from a geriatric population. Based on what appropriate symptoms does the nurse select the patients? Select all that apply. 1. The patient has difficulty in conversing with others. 2. The patient has poor judgment and decision-making. 3. The patient reports forgetting to pay the electric bills. 4. The patient reports frequently losing things and tracing them later. 5. The patient sometimes forgets which word to use during a conversation.

1. The patient has difficulty in conversing with others. 2. The patient has poor judgment and decision-making. Geriatric patients normally have minor age-related deflects in memory. The nurse should be able to differentiate between the normal age-related changes and signs of Alzheimer's disease. Patients with Alzheimer's disease have difficulty in conversation and poor judgment and decision making. Other symptoms include inability to manage a budget, losing track of the date or the season, misplacing things and being unable to trace them. Normal age-related changes include forgetting which word to use and losing things frequently. Missing monthly payments and making a bad decision once in a while is a normal behavior and does not indicate Alzheimer's disease.

A patient with Parkinson's disease reports that bugs are crawling on his bed. The nurse checks the bed and finds peanuts on the bed. What does the nurse conclude from the patient's behavior? 1. The patient has impaired environmental interpretation syndrome. 2. The patient has delusions. 3. The patient has developed an allergy to peanuts. 4. The patient has a skin disorder.

1. The patient has impaired environmental interpretation syndrome. Patients with Parkinson's disease have confusion and dementia, and have impaired environmental interpretation syndrome. It is characterized by hallucinations and illusions. The patients tend to mistake benign objects for objects which are sinister and frightening. The patients may have tactile hallucinations, but not suffer from delusions. An allergy to peanuts or developing a skin disorder are unlikely causes of the patient's complaint, as these disorders are accompanied by other symptoms as well.

A Chinese-American patient has been diagnosed with dementia. What should the nurse keep in mind when addressing the needs of the family caregivers? Select all that apply. 1. They do not seek help from others. 2. They believe dementia is due to fate. 3. They associate dementia with stigma. 4. They perceive caregiving as burdensome. 5. They feel obligated to sacrifice individual needs. 6. They believe memory loss in early dementia is not a mental disease.

1. They do not seek help from others. 2. They believe dementia is due to fate. 3. They associate dementia with stigma. 5. They feel obligated to sacrifice individual needs. 6. They believe memory loss in early dementia is not a mental disease. Chinese-Americans depict dementia as fate or wrongdoing rather than a disease. They are less likely to seek help from others. Filial piety and family harmony are important, which emphasizes honor and devotion to parents. They feel obligated to sacrifice individual needs and wants. As the disease progresses, dementia is viewed as a mental illness with associated stigma and resulting in feelings of humiliation. Chinese-Americans do not perceive their caregiving role as burdensome. They believe that memory loss in early dementia is a part of the normal aging process. It is not viewed as a mental illness.

A female patient is brought to the hospital by her daughter, who visited the patient this morning and found her to be confused and disoriented. When the patient is admitted, the daughter states, "I'll take her glasses and hearing aid home, so they don't get lost." What would be the best response from the nurse? 1. "That will be fine. I'll have you sign our hospital release form." 2. "I would like to have your mother wear them. It will help her to be less confused." 3. "Don't worry. You can leave them at her bedside. We are insured for losses of this sort." 4. "Because we do not have a copy of durable power of attorney, we cannot release them to you."

2. "I would like to have your mother wear them. It will help her to be less confused." Patients with cognitive disorders usually profit from being able to see and hear clearly. Confusion is reduced through the use of glasses and hearing aids.

A patient diagnosed with Alzheimer's disease picks up his or her glasses from the bedside table but does not recognize what they are or their purpose. The nurse will document this behavior using which term? 1. Apraxia 2. Agnosia 3 Aphasia 4 Agraphia

2. Agnosia Agnosia is the loss of the sensory ability to recognize objects. Apraxia is the loss of purposeful movement in the absence of motor or sensory impairment. Aphasia is the loss of language ability. Agraphia is the loss of the ability to read or write.

Which nursing intervention would be most appropriate for an older individual suspected of being at risk for the development of the unique symptoms of delirium? 1. Assuring that the individual is ambulated sufficiently. 2. Assessing orientation to person, place, and time every two hours. 3. Cutting the individual's food into small pieces to avoid the risk of choking. 4. Assuring that the individual is dressed warmly to avoid the risk of hypothermia.

2. Assessing orientation to person, place, and time every two hours. Delirium reduces awareness of the environment that involves sensory misperceptions and disordered thought (disturbed attention, memory, thinking, and orientation) and also disturbances of psychomotor activity and the sleep-wake cycle. These disturbances develop rapidly (over hours to days). Frequent assessment of an individual at risk for developing delirium for orientation would be most appropriate. Assuring ambulation, cutting food into small pieces, and assuring warm clothing are appropriate but not needs unique to an individual at risk for developing delirium.

The family caregivers of an elderly Alzheimer's disease patient are feeling overburdened and overwhelmed by the situation and wish to admit the patient to an assisted care facility. What could be the primary reason? 1. Family discord 2.Caregiver role strain 3 Disruption of social life 4 Distress, guilt, rejection

2. Caregiver role strain Many families take care of the patient with Alzheimer's disease until death. Others, however, find that they can no longer cope with aggressive behavior, incontinence, wandering, unsafe behaviors, or disruptive nocturnal activity. This is known as caregiver role strain. In such cases, the caregivers may admit the patient to an assisted care facility. Disruption of social life, distress, guilt, rejection, and family discord can all be burdens on the family but are not the primary reasons in this case.

An elderly patient is diagnosed with Alzheimer's disease. What characteristic features may be seen in this patient? Select all that apply. 1.Speaks rapidly, inappropriately, and incoherently 2. Forgets familiar words or the location of everyday objects 3 . Becomes moody or withdrawn, especially in challenging situations 4. Shows altered awareness and is unable to focus, or sustain attention 5. Has increasing and frequent trouble controlling bladder and bowels

2. Forgets familiar words or the location of everyday objects 3. Becomes moody or withdrawn, especially in challenging situations 5. Has increasing and frequent trouble controlling bladder and bowels Alzheimer's disease is characterized by progressive deterioration of cognitive functioning, including forgetting familiar words or the location of everyday objects. The patient becomes moody or withdrawn, especially in socially or mentally challenging situations. The patient also has increasing and frequent trouble controlling their bladder and bowels. Delirium is an acute cognitive disturbance where the patient's speech is rapid, inappropriate, incoherent, and rambling. There is an alteration in consciousness levels. This manifests as altered awareness and inability to focus, sustain, and shift attention.

A patient's family expresses concern that the patient is developing Alzheimer disease. The patient is now 65 and was once a professional wrestler. How might this history affect the diagnosis? 1. This history will not affect the diagnosis. 2. History of head trauma is a risk factor for dementia. 3. The patient is too young to have Alzheimer disease. 4. As an athlete, the patient is less likely to have Alzheimer disease.

2. History of head trauma is a risk factor for dementia. If the patient was a professional athlete in a contact sport, there may be a history of head injury, which will affect the diagnosis. The patient's history can indeed affect the diagnosis. Although most patients who are diagnosed with Alzheimer disease are 75 or older, it is not impossible for younger patients to show signs of the disease. Other than the risk of head trauma, athletes are no more or less likely to develop the disease.

Which is a drawback of early cholinesterase inhibitors? 1. Constipation 2. Liver toxicity 3. Only useful in mild dementia 4. Increased acetylcholine levels

2. Liver toxicity Earlier forms of cholinesterase inhibitors, such as tacrine, caused liver toxicity, causing them to be withdrawn from the US market in 2012. Increasing availability of acetylcholine is a benefit for patients with dementia. These drugs are not beneficial for people with mild dementia. The side effects include nausea, vomiting, and diarrhea, not constipation.

An elderly patient, who had been healthy and living independently, was hospitalized with heart failure. The patient was treated with diuretics and antihypertensive medications. On the third hospital day, the patient became very irritable and said, "Little yellow bugs are crawling across my sheets." What is the best analysis of this scenario? 1. the pt has delusions secondary to depression 2. the pt is experiencing illusions secondary to delirium 3. Early dementia emerged because of the stress of the physical illness 4. doses of antihypertensive drugs have not managed the patients BP

2. The patient is experiencing illusions secondary to delirium Delirium is the most common complication of hospitalizations in the older adults. Illusions (errors in perception of sensory stimuli) indicate this patient is confused. Illusions, irritability, and restlessness are common in delirium. The scenario doesn't suggest the pt has dementia or depression. The pt is likely experiencing toxicity associated with the multiple medications, which is a common cause of delirium.

An elderly patient is hospitalized with pneumonia and treated with multiple antibiotics. After two days, the patient becomes irritable and restless, and says to the nurse, "My pet parakeet flew across the room." A family member says the patient has been healthy and living independently but does not own a pet. What is the most likely analysis of this scenario? 1. The patient is delusional and likely experiencing depression. 2. The patient is experiencing illusions secondary to delirium. 3. The antibiotic doses have been inadequate to treat the infection. 4. Dementia has emerged as the result of the stress of the physical illness.

2. The patient is experiencing illusions secondary to delirium. The onset of the change in mental status is acute, which is characteristic of delirium. The vision of a bird flying in the room is likely an illusion, another common characteristic of delirium. The patient's condition could be the result of the medical illness, toxicity of the drug regimen, overstimulation from the hospital environment, alcohol withdrawal, or other reasons.

A patient with cognitive impairment is diagnosed with aphasia. Which symptom is the nurse most likely to find in the patient? 1. The patient wears socks on the hands. 2. The patient talks rapidly and foolishly. 3. The patient doesn't answer the nurse. 4. The patient doesn't identify sounds.

2. The patient talks rapidly and foolishly. Patients with impaired cognition show symptoms like aphasia, apraxia, preservation, and agnosia. The patient with aphasia has reduced language ability, seen as inability to use the correct word and talking rapidly and foolishly. Loss of purposeful movement is called apraxia. The person is unable to put on clothes and may wear socks on hands. The patient with preservation avoids answering the question to maintain self-esteem. Inability to identify sounds, objects, and people is known as agnosia.

7. According to Maslow's hierarchy of needs, the most basic needs category for nurses to address is: a. physiological b. safety c. love and belonging d. self-actualization

a

A nurse communicates with a diabetic patient during their regular check-up. The nurse finds that the patient is showing symptoms of Alzheimer's disease. Which response by the patient supports the nurse's diagnosis? 1. "I missed my walk last week." 2. "I regularly go for a walk, you can ask my daughter." 3. "I regularly meet Mr. Abraham Lincoln during my walk." 4. "I don't go for a walk, because it is very cold in the morning."

3. "I regularly meet Mr. Abraham Lincoln during my walk." Patients with Alzheimer's have progressive deterioration of memory. They forget to take medication and perform important self-care activities. They tend to hide the truth by creating stories like they go for a walk with Abraham Lincoln. This behavior is called confabulation. It is not the same as lying because patients do it unconsciously to maintain self-esteem. The statement that the patient is going for a regular walk which can be confirmed with the daughter indicates confidence. The statement that the patient missed the walk indicates that the patient remembers the period and also accepts the mistake. The statement that the patient doesn't go for a walk because of cold weather indicates that the patient accepts the mistake without any guilt.

Which patient outcome is directly associated with the goals of a therapeutic nurse-patient relationship? A) Patient will be respectful of other patients on the unit B) Patient will identify suicidal feelings to staff whenever they occur C) Patient will engage in at least one social interaction with the unit population daily D) Patient will consume a daily diet to meet both nutritional and hydration needs

B) Patient will identify suicidal feelings to staff whenever they occur

A patient repeatedly stated, "I'm stupid." Which statement by that patient would show progress resulting from cognitive-behavioral therapy? a. "Sometimes I do stupid things." b. "Things always go wrong for me." c. "I always fail when I try new things." d. "I'm disappointed in my lack of ability."

A "I'm stupid" is a cognitive distortion. A more rational thought is "Sometimes I do stupid things." The latter thinking promotes emotional self-control. The distracters reflect irrational or distorted thinking. This item relates to an audience response question.

During a one-on-one interaction with the nurse, a patient frequently looks nervously at the door. Select the best comment by the nurse regarding this nonverbal communication. a. "I notice you keep looking toward the door." b. "This is our time together. No one is going to interrupt us." c. "It looks as if you are eager to end our discussion for today." d. "If you are uncomfortable in this room, we can move someplace else."

A Making observations and encouraging the patient to describe perceptions are useful therapeutic communication techniques for this situation. The other responses are assumptions made by the nurse.

A nurse uses Maslow's hierarchy of needs to plan care for a patient diagnosed with mental illness. Which problem will receive priority? The patient a. refuses to eat or bathe. b. reports feelings of alienation from family. c. is reluctant to participate in unit social activities. d. is unaware of medication action and side effects.

A The need for food and hygiene are physiological and therefore take priority over psychological or meta-needs in care planning.

Sullivan viewed anxiety as: A) emotional experience felt after the age of 5 years. B) a sign of guilt in adults. C) any painful feeling or emotion arising from social insecurity. D) adults trying to go beyond experiences of guilt and pain.

C Any painful feeling or emotion arising from social insecurity

A patient is brought to the emergency room after falling in the street a mile from home. There are no serious injuries. The patient's medical record states the patient has Alzheimer disease, and the patient asks the nurse call his or her spouse, who is long deceased. What should be the focus of care? 1. Family therapy for the patient's family members 2. Health promotion, instructing the patient on ways to be safe 3. Evaluation of the home situation for safety and level of care 4. Biological reasons for the ER visit and possible psychiatric care

3. Evaluation of the home situation for safety and level of care Because patients with Alzheimer disease are at risk for wandering and getting lost, this patient's living situation should be assessed for security; he or she may require full-time care. Because the patient has no serious injuries, biological needs have already been addressed. Telling the patient how to be safe will not be effective due to the nature of the disorder. Family therapy may be helpful, but this is not the priority goal.

The nurse is assessing a patient suspected of Alzheimer's disease (AD). What action by the patient does the nurse identify as a sign of agnosia? 1. Babbles and speaks incoherently when asked any question 2. Has problem in recalling what was served for breakfast an hour ago 3. Has problem in identifying familiar sounds like the ring of the telephone 4. Talks about how he or she convinced the President to pass a particular law

3. Has problem in identifying familiar sounds like the ring of the telephone When the patient is unable to identify the ring of the telephone, it means there is a loss of sensory ability to recognize familiar sounds. The nurse recognizes it as a feature of auditory agnosia. If the patient babbles and speaks incoherently, it means there is a loss of language ability. The nurse identifies this as a sign of aphasia. In AD, there is a gradual deterioration of recent and remote memory. If the patient is unable to recall what was served for breakfast an hour ago, it indicates impairment of recent memory. Patients with AD often confabulate in an unconscious attempt to maintain self-esteem. When the patient talks about how the President's decision was influenced by the patient, the nurse should recognize it as confabulation.

Which risk factor for delirium is a direct result of external factors? 1. Fractures 2. Older age 3. Polypharmacy 4. Multiple comorbidities

3. Polypharmacy Delirium may occur as a result of polypharmacy, which can occur from a lack of continuity of care and communication, external factors. Older age and multiple conditions are internal factors. Fractures may be a result of an external cause but could also be a result of internal osteoporotic changes.

Every evening, several residents on the Alzheimer disease wing of a long-term care facility become excessively agitated. What is the term for this phenomenon? 1. Apraxia 2. Agraphia 3. Sundowning 4. Confabulation

3. Sundowning Sundowning is the term for the increase in agitation and decrease in mood in the later part of the day or night common among patients with Alzheimer disease. Confabulation describes the creation of vivid stories instead of actual memories. Agraphia refers to diminishment of reading and writing abilities. Apraxia is the loss of purposeful movement.

An important question to ask during the assessment of a client diagnosed with anxiety disorder is: A. "How often do you hear voices?" B. "Have you ever considered suicide?" C. "How long has your memory been bad?" D. "Do your thoughts always seem jumbled?"

B. "Have you ever considered suicide?" The presence of anxiety may cause an individual to consider suicide as a means of finding comfort and peace. Suicide assessment is appropriate for any client with higher levels of anxiety.

Which therapeutic intervention can the nurse implement personally to help a client diagnosed with a mild anxiety disorder regain control? A. Flooding B. Modeling C. Thought stopping D. Systematic desensitization

B. Modeling Modeling calm behavior in the face of anxiety or unafraid behavior in the presence of a feared stimulus are interventions that can be independently used. The other options require agreement of the treatment team.

A patient with acute depression states, "God is punishing me for my past sins." What is the nurse's most therapeutic response? a. "You sound very upset about this." b. "God always forgives us for our sins." c. "Why do you think you are being punished?" d. "If you feel this way, you should talk to your minister."

A The nurse reflects the patient's comment, a therapeutic technique to encourage sharing for perceptions and feelings. The incorrect responses reflect probing, closed-ended comments, and giving advice, all of which are nontherapeutic.

A 60 year old male recently diagnosed with cancer makes the statement, "I'll never live a happy life again." This is an example of? Overgeneralization Mindfulness Biofeedback Humor

overgeneralization

The term "perceptual disturbance" refers to difficulty accomplishing what task? 1. Formulating words appropriately. 2. Performing purposeful motor movements. 3. Changing one's way of thinking to accommodate new information. 4. The processing of information about one's internal and external environment.

4. The processing of information about one's internal and external environment. Perceptual disturbance refers to an impaired ability to process intellectual, sensory, and emotional data in a logical, meaningful way. Changing one's way of thinking to accommodate new information, performing purposeful motor movements, and formulating words appropriately fail to adequately describe the term perceptual disturbance.

A potential problem for a client diagnosed with severe obsessive-compulsive disorder is: A. sleep disturbance. B. excessive socialization. C. command hallucinations. D. altered state of consciousness.

A. sleep disturbance. Clients who must engage in compulsive rituals for anxiety relief are rarely afforded relief for any prolonged period. The high anxiety level and need to perform the ritual may interfere with sleep.

Which technique is most applicable to aversion therapy? a. Punishment b. Desensitization c. Role modeling d. Positive reinforcement

A Aversion therapy is akin to punishment. Aversive techniques include pairing of a maladaptive behavior with a noxious stimulus, punishment, and avoidance training.

While talking with a patient diagnosed with major depressive disorder, a nurse notices the patient is unable to maintain eye contact. The patient's chin lowers to the chest. The patient looks at the floor. Which aspect of communication has the nurse assessed? a. Nonverbal communication b. A message filter c. A cultural barrier d. Social skills

A Eye contact and body movements are considered nonverbal communication. There are insufficient data to determine the level of the patient's social skills or an existing cultural barrier.

A patient is having difficulty making a decision. The nurse has mixed feelings about whether to provide advice. Which principle usually applies? Giving advice a. is rarely helpful. b. fosters independence. c. lifts the burden of personal decision making. d. helps the patient develop feelings of personal adequacy.

A Giving advice fosters dependence on the nurse and interferes with a patient's right to make personal decisions. It robs the patient of the opportunity to weigh alternatives and develop problem-solving skills. Furthermore, it may contribute to a patient's feelings of personal inadequacy. Giving advice also keeps the nurse in control and feeling powerful.

Which technique will best communicate to a patient that the nurse is interested in listening? a. Restating a feeling or thought the patient has expressed. b. Asking a direct question, such as "Did you feel angry?" c. Making a judgment about the patient's problem. d. Saying, "I understand what you're saying."

A Restating allows the patient to validate the nurse's understanding of what has been communicated. Restating is an active listening technique. Judgments should be suspended in a nurse-patient relationship. Close-ended questions such as "Did you feel angry?" ask for specific information rather than showing understanding. When the nurse simply states that he or she understands the patient's words, the patient has no way of measuring the understanding.

A patient is suspicious and frequently manipulates others. To which psychosexual stage do these traits relate? a. Oral b. Anal c. Phallic d. Genital

A The behaviors in the stem develop as the result of attitudes formed during the oral stage, when an infant first learns to relate to the environment. Anal-stage traits include stinginess, stubbornness, orderliness, or their opposites. Phallic-stage traits include flirtatiousness, pride, vanity, difficulty with authority figures, and difficulties with sexual identity. Genital-stage traits include the ability to form satisfying sexual and emotional relationships with members of the opposite sex, emancipation from parents, a strong sense of personal identity, or the opposites of these traits.

Which patient is the best candidate for brief psychodynamic therapy? a. An accountant with a loving family and successful career who was involved in a short extramarital affair b. An adult with a long history of major depression who was charged with driving under the influence c. A woman with a history of borderline personality disorder who recently cut both wrists d. An adult male recently diagnosed with anorexia nervosa

A The best candidates for psychodynamic therapy are relatively healthy and well-functioning individuals, sometimes referred to as the "worried well," who have a clearly circumscribed area of difficulty and are intelligent, psychologically minded, and well-motivated for change. Patients with psychosis, severe depression, borderline personality disorders, and severe character disorders are not appropriate candidates for this type of treatment.

A 4-year-old grabs toys from other children and says, "I want that now!" From a psychoanalytic perspective, this behavior is a product of impulses originating in which system of the personality? a. Id b. Ego c. Superego d. Preconscious

A The id operates on the pleasure principle, seeking immediate gratification of impulses. The ego acts as a mediator of behavior and weighs the consequences of the action, perhaps determining that taking the toy is not worth the mother's wrath. The superego would oppose the impulsive behavior as "not nice." The preconscious is a level of awareness rather than an aspect of personality.

When a female Mexican American patient and a female nurse sit together, the patient often holds the nurse's hand. The patient also links arms with the nurse when they walk. The nurse is uncomfortable with this behavior. Which analysis is most accurate? a. The patient is accustomed to touch during conversation, as are members of many Hispanic subcultures. b. The patient understands that touch makes the nurse uncomfortable and controls the relationship based on that factor. c. The patient is afraid of being alone. When touching the nurse, the patient is reassured and comforted. d. The patient is trying to manipulate the nurse using nonverbal techniques.

A The most likely answer is that the patient's behavior is culturally influenced. Hispanic women frequently touch women they consider to be their friends. Although the other options are possible, they are less likely.

Consider this comment from a therapist: "The patient is homosexual but has kept this preference secret. Severe anxiety and depression occur when the patient anticipates family reactions to this sexual orientation." Which perspective is evident in the speaker? a. Theory of interpersonal relationships b. Classical conditioning theory c. Psychosexual theory d. Behaviorism theory

A The theory of interpersonal relationships recognizes the anxiety and depression as resulting from unmet interpersonal security needs. Behaviorism and classical conditioning theories do not apply. A psychosexual formulation would focus on uncovering unconscious material that relates to the patient problem.

The premise underlying behavioral therapy is a. Behavior is learned and can be modified. b. Behavior is a product of unconscious drives. c. Motives must change before behavior changes. d. Behavior is determined by cognitions; change in cognitions produces new behavior.

A Behavior is learned and can be modified.

One implication of Freud's theory of the unconscious on psychiatric mental health nursing is related to the consideration that conscious and unconscious influences can help nurses better understand a. the root causes of client suffering. b. the client's immature behavior. c. the client's interpersonal interactions. d. the client's psychological ability to reason.

A the root causes of client suffering

Mary is a 39-year-old attending a psychiatric outpatient clinic. Mary believes that her husband, sister, and son caused her problems. Listening to Mary describe the problems the nurse displays therapeutic communication in which response? A) "I understand you are in a difficult situation" B) "Thinking about being wronged repeatedly does more harm than good" C) "I feel bad about your situation, and I am so sorry it is happening to you and your family" D) "It must be so difficult to live with uncaring people"

A) "I understand you are in a difficult situation"

The patient expresses sadness at "being all alone with no one to share my life with." Which response by the nurse demonstrates the existence of a therapeutic relationship? A) "Loneliness can be a very painful and difficult emotion" B) "Let's talk and see if you and I have any interests in common" C) "I use Facebook to find people who share my love of cooking" D) "Loneliness is managed by getting involved with people"

A) "Loneliness can be a very painful and difficult emotion"

Which patient statement demonstrates a value held regarding children? A) "Nothing is more important to me than the safety of my children" B) "I believe my spouse wants to leave both me and our children" C) "I don't think my child's success depends on going to college" D) "I know my children will help me through my hard times"

A) "Nothing is more important to me than the safety of my children"

Which benefits are most associated with use of telehealth technologies? (Select all that apply.) a. Cost savings for patients b. Maximize care management c. Access to services for patients in rural areas d. Prompt reimbursement by third-party payers e. Rapid development of trusting relationships with patients

A, B, C Telehealth has shown that it can maximize health and improve disease management skills and confidence with the disease process. Many rural parents have felt disconnected from services- telehealth technologies can solve those problems. Although telehealth's improved health outcomes regularly show cost savings for payers, one significant barrier is the current lack of reimbursement for remote patient monitoring by third-party payers. Telehealth technologies have not shown rapid development of trusting relationships.

A patient states, "I'm starting cognitive-behavioral therapy. What can I expect from the sessions?" Which responses by the nurse would be appropriate? (Select all that apply.) a. "The therapist will be active and questioning." b. "You will be given some homework assignments." c. "The therapist will ask you to describe your dreams." d. "The therapist will help you look at your ideas and beliefs about yourself." e. "The goal is to increase subjectivity about thoughts that govern your behavior."

A, B, D Cognitive therapists are active rather than passive during therapy sessions because they help patient's reality-test their thinking. Homework assignments are given and completed outside the therapy sessions. Homework is usually discussed at the next therapy session. The goal of cognitive therapy is to assist the patient in identifying inaccurate cognitions and in reality-testing and formulating new, accurate cognitions. One distracter applies to psychoanalysis. Increasing subjectivity is not desirable.

A nurse interacts with patients diagnosed with various mental illnesses. Which statements reflect use of therapeutic communication? (Select all that apply.) a. "Tell me more about that situation." b. "Let's talk about something else." c. "I notice you are pacing a lot." d. "I'll stay with you a while." e. "Why did you do that?"

A, C, D The correct responses demonstrate use of the therapeutic techniques making an observation and showing empathy. The incorrect responses demonstrate changing the subject and probing, which are nontherapeutic techniques

A cultural characteristic that may be observed in a teenage, female Hispanic client in times of stress is to: A. suddenly tremble severely. B. exhibit stoic behavior. C. report both nausea and vomiting. D. laugh inappropriately.

A. suddenly tremble severely. Ataque de nervios (attack of the nerves) is a culture-bound syndrome that is seen in undereducated, disadvantaged females of Hispanic ethnicity.

Which comments by an elderly person best indicate successful completion of the individual's psychosocial developmental task? (Select all that apply.) a. "I am proud of my children's successes in life." b. "I should have given to community charities more often." c. "My relationship with my father made life more difficult for me." d. "My experiences in the war helped me appreciate the meaning of life." e. "I often wonder what would have happened if I had chosen a different career."

A, D The developmental crisis for an elderly person relates to integrity versus despair. Pride in one's offspring indicates a sense of fulfillment. Recognition of the wisdom gained from difficult experiences (such as being in a war) indicates a sense of integrity. Blaming and regret indicate despair and unsuccessful resolution of the crisis.

Which comments by an adult best indicate self-actualization? (Select all that apply.) a. "I am content with a good book." b. "I often wonder if I chose the right career." c. "Sometimes I think about how my parents would have handled problems." d. "It's important for our country to provide basic health care services for everyone." e. "When I was lost at sea for 2 days, I gained an understanding of what is important."

A, D, E Self-actualized persons enjoy privacy, have a sense of democracy, and show positive outcomes associated with peak experiences. Self-doubt, defensiveness, and blaming are not consistent with self-actualization.

A client who is demonstrating a moderate level of anxiety tells the nurse, "I am so anxious, and I do not know what to do." A helpful response for the nurse to make would be: A. "What things have you done in the past that helped you feel more comfortable?" B. "Let's try to focus on that adorable little granddaughter of yours." C. "Why don't you sit down over there and work on that jigsaw puzzle?" D. "Try not to think about the feelings and sensations you're experiencing."

A. "What things have you done in the past that helped you feel more comfortable?" Because the client is not able to think through the problem and arrive at an action that would lower anxiety, the nurse can assist by asking what has worked in the past. Often what has been helpful in the past can be used again.

A possible outcome criterion for a client diagnosed with anxiety disorder is: A. Client demonstrates effective coping strategies. B. Client reports reduced hallucinations. C. Client reports feelings of tension and fatigue. D. Client demonstrates persistent avoidance behaviors.

A. Client demonstrates effective coping strategies. Option A is the only desirable outcome listed.

Generally, ego defense mechanisms: A. often involve some degree of self-deception. B. are rarely used by mentally healthy people. C. seldom make the person more comfortable. D. are usually effective in resolving conflicts.

A. often involve some degree of self-deception. Most ego defense mechanisms, with the exception of the mature defenses, alter the individual's perception of reality to produce varying degrees of self-deception.

Inability to leave one's home because of avoidance of severe anxiety suggests the anxiety disorder of: A. panic attacks with agoraphobia. B. obsessive-compulsive disorder. C. posttraumatic stress response. D. generalized anxiety disorder.

A. panic attacks with agoraphobia. Panic disorder with agoraphobia is characterized by recurrent panic attacks combined with agoraphobia. Agoraphobia involves intense, excessive anxiety about being in places or situations from which escape might be difficult or embarrassing or in which help might not be available if a panic attack occurred.

A client is experiencing a panic attack. The nurse can be most therapeutic by: A. telling the client to take slow, deep breaths. B. verbalizing mild disapproval of the anxious behavior. C. asking the client what he means when he says "I am dying." D. offering an explanation about why the symptoms are occurring

A. telling the client to take slow, deep breaths. Slow diaphragmatic breathing can induce relaxation and reduce symptoms of anxiety. Often the nurse has to tell the client to "breathe with me" and keep the client focused on the task. The slower breathing also reduces the threat of hypercapnia with its attendant symptoms.

*A patient says, "Please don't share information about me with the other people." How should the nurse respond?* a. "I will not share information with your family or friends without your permission, but I share information about you with other staff." b. "A therapeutic relationship is just between the nurse and the patient. It is up to you to tell others what you want them to know." c. "It depends on what you choose to tell me. I will be glad to disclose at the end of each session what I will report to others." d. "I cannot tell anyone about you. It will be as though I am talking about my own problems, and we can help each other by keeping it between us."

ANS: A A patient has the right to know with whom the nurse will share information and that confidentiality will be protected. Although the relationship is primarily between the nurse and patient, other staff needs to know pertinent data. The other incorrect responses promote incomplete disclosure on the part of the patient, require daily renegotiation of an issue that should be resolved as the nurse-patient contract is established, and suggest mutual problem solving. The relationship must be patient centered.

A community mental health nurse has worked with a patient for 3 years but is moving out of the city and terminates the relationship. When a novice nurse begins work with this patient, what is the starting point for the relationship? a. Begin at the orientation phase. b. Resume the working relationship. c. Initially establish a social relationship. d. Return to the emotional catharsis phase.

ANS: A After termination of a long-term relationship, the patient and new nurse usually have to begin at ground zero, the orientation phase, to build a new relationship. If termination is successfully completed, the orientation phase sometimes progresses quickly to the working phase. Other times, even after successful termination, the orientation phase may be prolonged.

A patient says, "I've done a lot of cheating and manipulating in my relationships." Select a nonjudgmental response by the nurse. a. "How do you feel about that?" b. "I am glad that you realize this." c. "That's not a good way to behave." d. "Have you outgrown that type of behavior?"

ANS: A Asking a patient to reflect on feelings about his or her actions does not imply any judgment about those actions, and it encourages the patient to explore feelings and values. The remaining options offer negative judgments.

Which statement shows a nurse has empathy for a patient who made a suicide attempt? a. "You must have been very upset when you tried to hurt yourself." b. "It makes me sad to see you going through such a difficult experience." c. "If you tell me what is troubling you, I can help you solve your problems." d. "Suicide is a drastic solution to a problem that may not be such a serious matter."

ANS: A Empathy permits the nurse to see an event from the patient's perspective, understand the patient's feelings, and communicate this to the patient. The incorrect responses are nurse- centered (focusing on the nurse's feelings rather than the patient's), belittling, and sympathetic.

A nurse explains to the family of a mentally ill patient how a nurse-patient relationship differs from social relationships. Which is the best explanation? a. "The focus is on the patient. Problems are discussed by the nurse and patient, but solutions are implemented by the patient." b. "The focus shifts from nurse to patient as the relationship develops. Advice is given by both, and solutions are implemented." c. "The focus of the relationship is socialization. Mutual needs are met, and feelings are shared openly." d. "The focus is creation of a partnership in which each member is concerned with growth and satisfaction of the other."

ANS: A Only the correct response describes elements of a therapeutic relationship. The remaining responses describe events that occur in social or intimate relationships.

As a patient diagnosed with a mental illness is being discharged from a facility, a nurse invites the patient to the annual staff picnic. What is the best analysis of this scenario? a. The invitation facilitates dependency on the nurse. b. The nurse's action blurs the boundaries of the therapeutic relationship. c. The invitation is therapeutic for the patient's diversional activity deficit. d. The nurse's action assists the patient's integration into community living.

ANS: B The invitation creates a social relationship rather than a therapeutic relationship.

As a nurse discharges a patient, the patient gives the nurse a card of appreciation made in an arts and crafts group. What is the nurse's best action? a. Recognize the effectiveness of the relationship and patient's thoughtfulness. Accept the card. b. Inform the patient that accepting gifts violates policies of the facility. Decline the card. c. Acknowledge the patient's transition through the termination phase but decline the card. d. Accept the card and invite the patient to return to participate in other arts and crafts groups.

ANS: A The nurse must consider the meaning, timing, and value of the gift. In this instance, the nurse should accept the patient's expression of gratitude.

At what point in the nurse-patient relationship should a nurse plan to first address termination? a. During the orientation phase b. At the end of the working phase c. Near the beginning of the termination phase d. When the patient initially brings up the topic

ANS: A The patient has a right to know the conditions of the nurse-patient relationship. If the relationship is to be time-limited, the patient should be informed of the number of sessions. If it is open-ended, the termination date will not be known at the outset, and the patient should know that the issue will be negotiated at a later date. The nurse is responsible for bringing up the topic of termination early in the relationship, usually during the orientation phase.

A nurse says, "I am the only one who truly understands this patient. Other staff members are too critical." The nurse's statement indicates: a. boundary blurring. c. positive regard. b. sexual harassment. d. advocacy.

ANS: A When the role of the nurse and the role of the patient shift, boundary blurring may arise. In this situation the nurse is becoming over-involved with the patient as a probable result of unrecognized countertransference. When boundary issues occur, the need for supervision exists. The situation does not describe sexual harassment. Data are not present to suggest positive regard or advocacy.

A nurse ends a relationship with a patient. Which actions by the nurse should be included in the termination phase? Select all that apply. a. Focus dialogues with the patient on problems that may occur in the future. b. Help the patient express feelings about the relationship with the nurse. c. Help the patient prioritize and modify socially unacceptable behaviors. d. Reinforce expectations regarding the parameters of the relationship. e. Help the patient to identify strengths, limitations, and problems.

ANS: A, B The correct actions are part of the termination phase. The other actions would be used in the working and orientation phases.

A novice psychiatric nurse has a parent with bipolar disorder. This nurse angrily recalls feelings of embarrassment about the parent's behavior in the community. Select the best ways for this nurse to cope with these feelings. Select all that apply. a. Seek ways to use the understanding gained from childhood to help patients cope with their own illnesses. b. Recognize that these feelings are unhealthy. The nurse should try to suppress them when working with patients. c. Recognize that psychiatric nursing is not an appropriate career choice. Explore other nursing specialties. d. The nurse should begin new patient relationships by saying, "My own parent had mental illness, so I accept it without stigma." e. Recognize that the feelings may add sensitivity to the nurse's practice, but supervision is important.

ANS: A, E The nurse needs support to explore these feelings. An experienced psychiatric nurse is a resource that may be helpful. The knowledge and experience gained from the nurse's relationship with a mentally ill parent may contribute sensitivity to compassionate practice. Self-disclosure and suppression are not adaptive coping strategies. The nurse should not give up on this area of practice without first seeking ways to cope with the memories.

A nurse introduces the matter of a contract during the first session with a new patient because contracts: a. specify what the nurse will do for the patient. b. spell out the participation and responsibilities of each party. c. indicate the feeling tone established between the participants. d. are binding and prevent either party from prematurely ending the relationship.

ANS: B A contract emphasizes that the nurse works with the patient rather than doing something for the patient. "Working with" is a process that suggests each party is expected to participate and share responsibility for outcomes. Contracts do not, however, stipulate roles or feeling tone, and premature termination is forbidden.

A nurse assesses a confused older adult. The nurse experiences sadness and reflects, "The patient is like one of my grandparents...so helpless." Which response is the nurse demonstrating? a. Transference b. Countertransference c. Catastrophic reaction d. Defensive coping reaction

ANS: B Countertransference is the nurse's transference or response to a patient that is based on the nurse's unconscious needs, conflicts, problems, or view of the world.

An advanced practice nurse observes a novice nurse expressing irritability regarding a patient with a long history of alcoholism and suspects the new nurse is experiencing countertransference. Which comment by the new nurse confirms this suspicion? a. "This patient continues to deny problems resulting from drinking." b. "My parents were alcoholics and often neglected our family." c. "The patient cannot identify any goals for improvement." d. "The patient said I have many traits like her mother."

ANS: B Countertransference occurs when the nurse unconsciously and inappropriately displaces onto the patient feelings and behaviors related to significant figures in the nurse's past. In this instance, the new nurse's irritability stems from relationships with parents. The distracters indicate transference or accurate analysis of the patient's behavior.

A nurse wants to demonstrate genuineness with a patient diagnosed with schizophrenia. The nurse should: a. restate what the patient says. b. use congruent communication strategies. c. use self-revelation in patient interactions. d. consistently interpret the patient's behaviors.

ANS: B Genuineness is a desirable characteristic involving awareness of one's own feelings as they arise and the ability to communicate them when appropriate. The incorrect options are undesirable in a therapeutic relationship.

A nurse wants to enhance growth of a patient by showing positive regard. The nurse's action most likely to achieve this goal is: a. making rounds daily. b. staying with a tearful patient. c. administering medication as prescribed. d. examining personal feelings about a patient.

ANS: B Staying with a crying patient offers support and shows positive regard. Administering daily medication and making rounds are tasks that could be part of an assignment and do not necessarily reflect positive regard. Examining feelings regarding a patient addresses the nurse's ability to be therapeutic.

Which descriptors exemplify consistency regarding nurse-patient relationships? Select all that apply. a. Encouraging a patient to share initial impressions of staff b. Having the same nurse care for a patient on a daily basis c. Providing a schedule of daily activities to a patient d. Setting a time for regular sessions with a patient e. Offering solutions to a patient's problems

ANS: B, C, D Consistency implies predictability. Having the same nurse see the patient daily and provide a daily schedule of patient activities and a set time for regular sessions will help a patient predict what will happen during each day and develop a greater degree of security and comfort. Encouraging a patient to share initial impressions of staff and giving advice are not related to consistency and would not be considered a therapeutic intervention.

A novice nurse tells a mentor, "I want to convey to my patients that I am interested in them and that I want to listen to what they have to say." Which behaviors will be helpful in meeting the nurse's goal? Select all that apply. a. Sitting behind a desk, facing the patient b. Introducing self to a patient and identifying own role c. Maintaining control of discussions by asking direct questions d. Using facial expressions to convey interest and encouragement e. Assuming an open body posture and sometimes mirror imaging

ANS: B, D, E Trust is fostered when the nurse gives an introduction and identifies his or her role. Facial expressions that convey interest and encouragement support the nurse's verbal statements to that effect and strengthen the message. An open body posture conveys openness to listening to what the patient has to say. Mirror imaging enhances patient comfort. A desk would place a physical barrier between the nurse and patient. A face-to-face stance should be avoided when possible and a less intense 90- or 120-degree angle used to permit either party to look away without discomfort.

Which behavior shows that a nurse values autonomy? The nurse: a. suggests one-on-one supervision for a patient who has suicidal thoughts. b. informs a patient that the spouse will not be in during visiting hours. c. discusses options and helps the patient weigh the consequences. d. sets limits on a patient's romantic overtures toward the nurse.

ANS: C A high level of valuing is acting on one's belief. Autonomy is supported when the nurse helps a patient weigh alternatives and their consequences before the patient makes a decision. Autonomy or self-determination is not the issue in any of the other behaviors.

As a nurse escorts a patient being discharged after treatment for major depression, the patient gives the nurse a necklace with a heart pendant and says, "Thank you for helping mend my broken heart." Which is the nurse's best response? a. "Accepting gifts violates the policies and procedures of the facility." b. "I'm glad you feel so much better now. Thank you for the beautiful necklace." c. "I'm glad I could help you, but I can't accept the gift. My reward is seeing you with a renewed sense of hope." d. "Helping people is what nursing is all about. It's rewarding to me when patients recognize how hard we work."

ANS: C Accepting a gift creates a social rather than therapeutic relationship with the patient and blurs the boundaries of the relationship. A caring nurse will acknowledge the patient's gesture of appreciation, but the gift should not be accepted.

What is the desirable outcome for the orientation stage of a nurse-patient relationship? The patient will demonstrate behaviors that indicate: a. self-responsibility and autonomy. b. a greater sense of independence. c. rapport and trust with the nurse. d. resolved transference.

ANS: C Development of rapport and trust is necessary before the relationship can progress to the working phase. Behaviors indicating a greater sense of independence, self-responsibility, and resolved transference occur in the working phase.

During which phase of the nurse-patient relationship can the nurse anticipate that identified patient issues will be explored and resolved? a. Preorientation b. Orientation c. Working d. Termination

ANS: C During the working phase, the nurse strives to assist the patient in making connections among dysfunctional behaviors, thinking, and emotions and offers support while alternative coping behaviors are tried.

A patient says, "I'm still on restriction, but I want to attend some off-unit activities. Would you ask the doctor to change my privileges?" What is the nurse's best response? a. "Why are you asking me when you're able to speak for yourself?" b. "I will be glad to address it when I see your doctor later today." c. "That's a good topic for you to discuss with your doctor." d. "Do you think you can't speak to a doctor?"

ANS: C Nurses should encourage patients to work at their optimal level of functioning. A nurse does not act for the patient unless it is necessary. Acting for a patient increases feelings of helplessness and dependency.

Which issues should a nurse address during the first interview with a patient with a psychiatric disorder? a. Trust, congruence, attitudes, and boundaries b. Goals, resistance, unconscious motivations, and diversion c. Relationship parameters, the contract, confidentiality, and termination d. Transference, countertransference, intimacy, and developing resources

ANS: C Relationship parameters, the contract, confidentiality, and termination are issues that should be considered during the orientation phase of the relationship. The remaining options are issues that are dealt with later.

*After several therapeutic encounters with a patient who recently attempted suicide, which occurrence should cause the nurse to consider the possibility of countertransference?* a. The patient's reactions toward the nurse seem realistic and appropriate. b. The patient states, "Talking to you feels like talking to my parents." c. The nurse feels unusually happy when the patient's mood begins to lift. d. The nurse develops a trusting relationship with the patient.

ANS: C Strong positive or negative reactions toward a patient or over-identification with the patient indicate possible countertransference. Nurses must carefully monitor their own feelings and reactions to detect countertransference and then seek supervision. Realistic and appropriate reactions from a patient toward a nurse are desirable. One incorrect response suggests transference. A trusting relationship with the patient is desirable.

*Termination of a therapeutic nurse-patient relationship has been successful when the nurse:* a. avoids upsetting the patient by shifting focus to other patients before the discharge. b. gives the patient a personal telephone number and permission to call after discharge. c. discusses with the patient changes that happened during the relationship and evaluates outcomes. d. offers to meet the patient for coffee and conversation three times a week after discharge.

ANS: C Summarizing and evaluating progress help validate the experience for the patient and the nurse and facilitate closure. Termination must be discussed; avoiding discussion by spending little time with the patient promotes feelings of abandonment. Successful termination requires that the relationship be brought to closure without the possibility of dependency-producing ongoing contact.

A nurse caring for a withdrawn, suspicious patient recognizes development of feelings of anger toward the patient. The nurse should: a. suppress the angry feelings. b. express the anger openly and directly with the patient. c. tell the nurse manager to assign the patient to another nurse. d. discuss the anger with a clinician during a supervisory session.

ANS: D The nurse is accountable for the relationship. Objectivity is threatened by strong positive or negative feelings toward a patient. Supervision is necessary to work through countertransference feelings.

Which remark by a patient indicates passage from orientation to the working phase of a nurse-patient relationship? a. "I don't have any problems." b. "It is so difficult for me to talk about problems." c. "I don't know how it will help to talk to you about my problems." d. "I want to find a way to deal with my anger without becoming violent."

ANS: D Thinking about a more constructive approach to dealing with anger indicates a readiness to make a behavioral change. Behavioral change is associated with the working phase of the relationship. Denial is often seen in the orientation phase. It is common early in the relationship, before rapport and trust are firmly established, for a patient to express difficulty in talking about problems. Stating skepticism about the effectiveness of the nurse-patient relationship is more typically a reaction during the orientation phase.

A patient says, "People should be allowed to commit suicide without interference from others." A nurse replies, "You're wrong. Nothing is bad enough to justify death." What is the best analysis of this interchange? a. The patient is correct. b. The nurse is correct. c. Neither person is correct. d. Differing values are reflected in the two statements.

ANS: D Values guide beliefs and actions. The individuals stating their positions place different values on life and autonomy. Nurses must be aware of their own values and be sensitive to the values of others.

A nurse is talking with a patient, and 5 minutes remain in the session. The patient has been silent most of the session. Another patient comes to the door of the room, interrupts, and says to the nurse, "I really need to talk to you." The nurse should: a. invite the interrupting patient to join in the session with the current patient. b. say to the interrupting patient, "I am not available to talk with you at the present time." c. end the unproductive session with the current patient and spend time with the interrupting patient. d. tell the interrupting patient, "This session is 5 more minutes; then I will talk with you."

ANS: D When a specific duration for sessions has been set, the nurse must adhere to the schedule. Leaving the first patient would be equivalent to abandonment and would destroy any trust the patient had in the nurse. Adhering to the contract demonstrates that the nurse can be trusted and that the patient and the sessions are important. The incorrect responses preserve the nurse-patient relationship with the silent patient but may seem abrupt to the interrupting patient, abandon the silent patient, or fail to observe the contract with the silent patient.

Which of the following are recognized as a "stress buster" to be incorporated in our lives to reduce stress with little effort. (select all that apply) About 20 minutes a day of moderate intensity aerobic activity Sleeping in later in the mornings Slowly weaning off coffee, tea, sodas and chocolate drinks getting a 60 minute massage listening to familiar types of music

About 20 minutes a day of moderate intensity aerobic activity Slowly weaning off coffee, tea, sodas and chocolate drinks getting a 60 minute massage listening to familiar types of music

A client diagnosed with Alzhemier's disease looks confused and cannot recall many common household objects by name, suchs as a pencil or glass. The nurse should document this loss of function using which term a) Apraxia b) Agnosia c) Aphasia d) Anhedonia

Agnosia

What are the three stages of the General Adaptation Syndrome (GAS)? Select all that apply Exhaustion Happiness Alarm Sadness Resistance

Alarm Resistance Exhaustion

Which type of dementia has a clear genetic link a) Alcohol-induced dementia b) Multi-infarct dementia c) Creutzfeldt-jakob disease d) Alzheimer's disease

Alzheimer's disease

Which type of dementia has a clear genetic link? Alcohol-induced dementia Multi-infarct dementia Creutzfeldt-Jakob disease Alzheimer's disease

Alzheimer's disease Family members of people with Alzheimer's disease have a higher risk of developing the disease than does the general population.REF: 436

A diagnosis of chronic stress is supported by which assessment finding? Select all that apply. Amenorrhea Loss of appetite History of panic attacks Insulin-resistant diabetes Recent treatment for blood clots

Amenorrhea History of panic attacks Insulin-resistant diabetes

Short-term effects of the hypothalamus-Pituitary-Adrenal Cortex (HYPAC) select all that apply Decrease fluid loss Increase glucose by gluconeogenesis Decrease inflammation Decrease brain norepinephrine

Decrease fluid loss Increase glucose by gluconeogenesis Decrease inflammation Decrease brain norepinephrine

Which problem is NOT considered a causative agent in delirium? Elevated blood urea nitrogen levels Infection Anticholinergic drugs Antibiotic therapy

Antibiotic therapy Although delirium may be a result of an infection, antibiotic therapy is not known to cause cognitive disorders.REF: 432-433

Which of the following cultures tends to express distress in somatic terms and experience it physically? (Select all that apply) Western European North Americans Asians Africans Central Americans

Asians Africans Central Americans

The first stage of the general adaptation syndrome (GAS) can be characterized by which response? Eustress Fight or flight Resistance Exhaustion

Fight or flight The initial adaptive response of the general adaptation syndrome prepares the individual to fight or flee in the face of acute stress. None of the other options are associated with the initial stage of GAS

What should the nurse do for a patient who is experiencing the alarm stage of stress? Assess for a dry mouth Determine the blood pressure Check oxygen saturation level Assess for signs of depression

Assess for a dry mouth

Which statement by a patient would lead the nurse to suspect unsuccessful completion of the psychosocial developmental task of infancy? a. "I know how to do things right, so I prefer jobs where I work alone rather than on a team." b. "I do not allow other people to truly get to know me." c. "I depend on frequent praise from others to feel good about myself." d. "I usually need to do things several times before I get them right."

B According to Erikson, the developmental task of infancy is the development of trust. The correct response is the only statement clearly showing lack of ability to trust others. An inability to work with others, coupled with a sense of superiority, suggests unsuccessful completion of the task of intimacy versus isolation. Relying on praise from others suggests unsuccessful completion of the task of identity versus role confusion. Shame suggests failure to resolve the crisis of initiative versus guilt.

A patient says, "All my life I've been surrounded by stupidity. Everything I buy breaks because the entire American workforce is incompetent." This patient is experiencing a a. self-esteem deficit. b. cognitive distortion. c. deficit in motivation. d. deficit in love and belonging.

B Automatic thoughts, or cognitive distortions, are irrational and lead to false assumptions and misinterpretations. See related audience response question.

A patient says, "I always feel good when I wear a size 2 petite." Which type of cognitive distortion is evident? a. Disqualifying the positive b. Overgeneralization c. Catastrophizing d. Personalization

B Automatic thoughts, or cognitive distortions, are irrational and lead to false assumptions and misinterpretations. The stem offers an example of overgeneralization.

A black patient says to a white nurse, "There's no sense talking about how I feel. You wouldn't understand because you live in a white world." The nurse's best action would be to a. explain, "Yes, I do understand. Everyone goes through the same experiences." b. say, "Please give an example of something you think I wouldn't understand." c. reassure the patient that nurses interact with people from all cultures. d. change the subject to one that is less emotionally disturbing.

B Having the patient speak in specifics rather than globally will help the nurse understand the patient's perspective. This approach will help the nurse engage the patient. Reassurance and changing the subject are not therapeutic techniques.

A patient diagnosed with schizophrenia tells the nurse, "The Central Intelligence Agency is monitoring us through the fluorescent lights in this room. The CIA is everywhere, so be careful what you say." Which response by the nurse is most therapeutic? a. "Let's talk about something other than the CIA." b. "It sounds like you're concerned about your privacy." c. "The CIA is prohibited from operating in health care facilities." d. "You have lost touch with reality, which is a symptom of your illness."

B It is important not to challenge the patient's beliefs, even if they are unrealistic. Challenging undermines the patient's trust in the nurse. The nurse should try to understand the underlying feelings or thoughts the patient's message conveys. The correct response uses the therapeutic technique of reflection. The other comments are nontherapeutic. Asking to talk about something other than the concern at hand is changing the subject. Saying that the CIA is prohibited from operating in health care facilities gives false reassurance. Stating that the patient has lost touch with reality is truthful, but uncompassionate.

A patient is fearful of riding on elevators. The therapist first rides an escalator with the patient. The therapist and patient then stand in an elevator with the door open for 5 minutes and later with the elevator door closed for 5 minutes. Which technique has the therapist used? a. Classic psychoanalytic therapy b. Systematic desensitization c. Rational emotive therapy d. Biofeedback

B Systematic desensitization is a form of behavior modification therapy that involves the development of behavior tasks customized to the patient's specific fears. These tasks are presented to the patient while using learned relaxation techniques. The patient is incrementally exposed to the fear.

A student nurse says, "I don't need to interact with my patients. I learn what I need to know by observation." An instructor can best interpret the nursing implications of Sullivan's theory to this student by responding: a. "Interactions are required in order to help you develop therapeutic communication skills." b. "Nurses cannot be isolated. We must interact to provide patients with opportunities to practice interpersonal skills." c. "Observing patient interactions will help you formulate priority nursing diagnoses and appropriate interventions." d. "It is important to pay attention to patients' behavioral changes, because these signify adjustments in personality."

B The nurse's role includes educating patients and assisting them in developing effective interpersonal relationships. Mutuality, respect for the patient, unconditional acceptance, and empathy are cornerstones of Sullivan's theory. The nurse who does not interact with the patient cannot demonstrate these cornerstones. Observations provide only objective data. Priority nursing diagnoses usually cannot be accurately established without subjective data from the patient. The other distracters relate to Maslow and behavioral theory. This item relates to an audience response question.

A nurse influenced by Peplau's interpersonal theory works with an anxious, withdrawn patient. Interventions should focus on a. rewarding desired behaviors. b. use of assertive communication. c. changing the patient's self-concept. d. administering medications to relieve anxiety.

B The nurse-patient relationship is structured to provide a model for adaptive interpersonal relationships that can be generalized to others. Helping the patient learn to use assertive communication will improve the patient's interpersonal relationships. The distracters apply to theories of cognitive, behavioral, and biological therapy.

The parent of a child diagnosed with schizophrenia tearfully asks the nurse, "What could I have done differently to prevent this illness?" Select the nurse's best response. a. "Although schizophrenia results from impaired family relationships, try not to feel guilty. No one can predict how a child will respond to parental guidance." b. "Schizophrenia is a biological illness resulting from changes in how the brain and nervous system function. You are not to blame for your child's illness." c. "There is still hope. Changing your parenting style can help your child learn to cope effectively with the environment." d. "Most mental illnesses result from genetic inheritance. Your genes are more at fault than your parenting."

B The parent's comment suggests feelings of guilt or inadequacy. The nurse's response should address these feelings as well as provide information. Patients and families need reassurance that the major mental disorders are biological in origin and are not the "fault" of parents. One distracter places the burden of having faulty genes on the shoulders of the parents. The other distracters are neither wholly accurate nor reassuring.

The patient says, "My marriage is just great. My spouse and I always agree." The nurse observes the patient's foot moving continuously as the patient twirls a shirt button. The conclusion the nurse can draw is that the patient's communication is a. clear. b. distorted. c. incongruous. d. inadequate.

B The patient's verbal and nonverbal communication in this scenario are incongruous. Incongruous messages involve transmission of conflicting messages by the speaker. The patient's verbal message that all was well in the relationship was modified by the nonverbal behaviors denoting anxiety. Data are not present to support the choice of the verbal message being clear, explicit, or inadequate.

A patient participated in psychotherapy weekly for 5 months. The therapist used free association, dream analysis, and facilitated transference to help the patient understand conflicts and foster change. Select the term that applies to this method. a. Rational-emotive behavior therapy b. Psychodynamic psychotherapy c. Cognitive-behavioral therapy d. Operant conditioning

B The techniques are aspects of psychodynamic psychotherapy. The distracters use other techniques.

A parent says, "My 2-year-old child refuses toilet training and shouts 'No!' when given directions. What do you think is wrong?" Select the nurse's best reply. a. "Your child needs firmer control. It is important to set limits now." b. "This is normal for your child's age. The child is striving for independence." c. "There may be developmental problems. Most children are toilet trained by age 2." d. "Some undesirable attitudes are developing. A child psychologist can help you develop a plan."

B This behavior is conventional of a child around the age of 2 years, whose developmental task is to develop autonomy. The distracters indicate the child's behavior is abnormal.

During the first interview with a parent whose child died in a car accident, the nurse feels empathic and reaches out to take the patient's hand. Select the correct analysis of the nurse's behavior. a. It shows empathy and compassion. It will encourage the patient to continue to express feelings. b. The gesture is premature. The patient's cultural and individual interpretation of touch is unknown. c. The patient will perceive the gesture as intrusive and overstepping boundaries. d. The action is inappropriate. Psychiatric patients should not be touched.

B Touch has various cultural and individual interpretations. Nurses should refrain from using touch until an assessment is completed regarding the way in which the patient will perceive touch. The incorrect options present prematurely drawn conclusions.

A patient says to the nurse, "My father has been dead for over 10 years, but talking to you is almost as comforting as the talks he and I had when I was a child." Which term applies to the patient's comment? a. Superego b. Transference c. Reality testing d. Counter-transference

B Transference refers to feelings a patient has toward the health care workers that were originally held toward significant others in his or her life. Counter-transference refers to unconscious feelings that the health care worker has toward the patient. The superego represents the moral component of personality it seeks perfection.

When asked, the nurse explains that a client's id is a. the control over the emotional frustration he feels over the loss of his job. b. the source of his instincts to save himself from hurting himself. c. not in place since he was abused after the age of 5 months. d. able to differentiate his believed experiences and reality.

B the source of his instincts to save himself from hurting himself

Which statement made by either the nurse or the patient demonstrates an ineffective patient-nurse relationship? A) "I've given a lot of thought about what triggers me to be so angry" B) "Why do you think it's acceptable for you to be so disrespectful to staff?" C) "Will your spouse be available to attend tomorrow's family group session?" D) "I wanted you to know that the medication seems to be helping me feel less anxious"

B) "Why do you think it's acceptable for you to be so disrespectful to staff?"

A male patient frequently inquires about the female student nurse's boyfriend, social activities, and school experiences. Which is the best initial response by the student? A) The student requests assignment to a patient of the same gender as the student B) She limits sharing personal information and stresses the patient-centered focus of the conversation C) The student shares information to make the therapeutic relationship more equal D) She explains that if he persists in focusing on her, she cannot work with him

B) She limits sharing personal information and stresses the patient-centered focus of the conversation

A patient cries as the nurse explores the patient's feelings about the death of a close friend. The patient sobs, "I shouldn't be crying like this. It happened a long time ago." Which responses by the nurse facilitate communication? (Select all that apply.) a. "Why do you think you are so upset?" b. "I can see that you feel sad about this situation." c. "The loss of a close friend is very painful for you." d. "Crying is a way of expressing the hurt you are experiencing." e. "Let's talk about something else because this subject is upsetting you."

B, C, D Reflecting ("I can see that you feel sad," "This is very painful for you") and giving information ("Crying is a way of expressing hurt") are therapeutic techniques. "Why" questions often imply criticism or seem intrusive or judgmental. They are difficult to answer. Changing the subject is a barrier to communication.

Which activities represent the art of nursing? (Select all that apply.) a. Administering medications on time to a group of patients b. Listening to a new widow grieve her husband's death c. Helping a patient obtain groceries from a food bank d. Teaching a patient about a new medication e. Holding the hand of a frightened patient

B, C, E Peplau described the science and art of professional nursing practice. The art component of nursing consists of the care, compassion, and advocacy nurses provide to enhance patient comfort and well-being. The science component of nursing involves the application of knowledge to understand a broad range of human problems and psychosocial phenomena, intervening to relieve patients' suffering and promote growth. See related audience response question.

What can be said about the comorbidity of anxiety disorders? A. Anxiety disorders generally exist alone. B. A second anxiety disorder may coexist with the first. C. Anxiety disorders virtually never coexist with mood disorders. D. Substance abuse disorders rarely coexist with anxiety disorders.

B. A second anxiety disorder may coexist with the first. In many instances, when one anxiety disorder is present, a second one coexists. Clinicians and researchers have clearly shown that anxiety disorders frequently co-occur with other psychiatric problems. Major depression often co-occurs and produces a greater impairment with poorer response to treatment.

Studies of clients diagnosed with posttraumatic stress disorder suggest that the stress response of which of the following is considered abnormal? A. Brainstem B. Hypothalamus-pituitary-adrenal system C. Frontal lobe D. Limbic system

B. Hypothalamus-pituitary-adrenal system Studies of clients with posttraumatic stress disorder suggest that the stress response of the hypothalamus-pituitary-adrenal system is abnormal.

Jerry is a 72-year-old patient with Parkinson's disease and anxiety. He is living by himself and has had several falls lately. His provider orders lorazepam, 1 mg PO bid, for anxiety. You question this order because: A. Jerry may become addicted faster than younger patients. B. Jerry is at risk for falls. C. Jerry has a history of nonadherence with medications. D. Jerry should be treated with cognitive therapies rather than medication because of his advanced age.

B. Jerry is at risk for falls. An important nursing intervention is to monitor for side effects of the benzodiazepines, including sedation, ataxia, and decreased cognitive function. In a patient who has a history of falls, lorazepam would be contraindicated because it may cause sedation and ataxia leading to more falls. There is no evidence to suggest that elderly patients become addicted faster than younger patients. A history of nonadherence would not lead to you to question this drug order. Medication and other therapies are used congruently with all age levels.

An obsession is defined as: A. thinking of an action and immediately taking the action. B. a recurrent, persistent thought or impulse. C. an intense irrational fear of an object or situation. D. a recurrent behavior performed in the same manner.

B. a recurrent, persistent thought or impulse. Obsessions are thoughts, impulses, or images that persist and recur so that they cannot be dismissed from the mind.

The nurse anticipates that the nursing history of a client diagnosed with obsessive compulsive disorder (OCD) will reveal: A. a history of childhood trauma. B. a sibling with the disorder. C. an eating disorder. D. a phobia as well.

B. a sibling with the disorder. Research shows that first-degree biological relatives of those with OCD have a higher frequency of the disorder than exists in the general population.

Stella brings her mother, Dorothy, to the mental health outpatient clinic. Dorothy has a history of anxiety. Stella and Dorothy both give information for the assessment interview. Stella states, "My mother lives with me since my dad died 6 months ago. For the past couple of months, every time I need to leave the house for work or anything else, Mom becomes extremely anxious and cries that something terrible is going to happen to me. She seems OK except for these times, but it's affecting my ability to go to work." You suspect: A. panic disorder. B. adult separation anxiety disorder. C. agoraphobia. D. social anxiety disorder.

B. adult separation anxiety disorder. People with separation anxiety disorder exhibit developmentally inappropriate levels of concern over being away from a significant other. There may also be fear that something horrible will happen to the other person. Adult separation anxiety disorder may begin in childhood or adulthood. The scenario doesn't describe panic disorder. Agoraphobia is characterized by intense, excessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing or in which help might not be available. Social anxiety disorder, also called social phobia, is characterized by severe anxiety or fear provoked by exposure to a social or a performance situation that will be evaluated negatively by others.

The defense mechanisms that can only be used in healthy ways include: A. suppression and humor. B. altruism and sublimation. C. idealization and splitting. D. reaction formation and denial.

B. altruism and sublimation. Altruism and sublimation are known as mature defenses. They cannot be used in unhealthy ways. Altruism results in resolving emotional conflicts by meeting the needs of others, and sublimation substitutes socially acceptable activity for unacceptable impulses.

The initial nursing action for a newly admitted anxious client is to: A. assess the client's use of defense mechanisms. B. assess the client's level of anxiety. C. limit environmental stimuli. D. provide antianxiety medication.

B. assess the client's level of anxiety. The priority nursing action is the assessment of the client's anxiety level.

It can be said that the onset of most anxiety disorders occurs: A. before the age of 20 years. B. before the age of 40 years. C. after the age of 40 years. D. scattered throughout the life span.

B. before the age of 40 years. Epidemiology reports indicate that the onset of most anxiety disorders occurs before age 40 years.

A client is diagnosed with generalized anxiety disorder (GAD). The nursing assessment supports this diagnosis when the client reports: A. that his symptoms started right after he was robbed at gunpoint. B. being so worried he hasn't been able to work for the last 12 months. C. that eating in public makes him extremely uncomfortable. D. repeatedly verbalizing his prayers helps him feel relaxed.

B. being so worried he hasn't been able to work for the last 12 months. GAD is characterized by symptomatology that lasts 6 months or longer.

A man continues to speak of his wife as though she were still alive, 3 years after her death. This behavior suggests the use of: A. altruism. B. denial. C. undoing. D. suppression.

B. denial. Denial involves escaping unpleasant reality by ignoring its existence.

Selective inattention is first noted when experiencing anxiety that is: A. mild. B. moderate. C. severe. D. panic.

B. moderate. When moderate anxiety is present, the individual's perceptual field is reduced and the client is not able to see the entire picture of events.

A teenager changes study habits to earn better grades after initially failing a test. This behavioral change is likely a result of: A. a rude awakening. B. normal anxiety. C. trait anxiety. D. altruism.

B. normal anxiety. Normal anxiety is a healthy life force needed to carry out the tasks of living and striving toward goals. It prompts constructive actions.

A 20-year-old was sexually molested at age 10, but he can no longer remember the incident. The ego defense mechanism in use is: A. projection. B. repression. C. displacement. D. reaction formation.

B. repression. Repression is a defense mechanism that excludes unwanted or unpleasant experiences, emotions, or ideas from conscious awareness.

A patient diagnosed with hypertension uses an automatic cycling blood pressure cuff with audible changing tones. The patient uses relaxation techniques to lower blood pressure and is informed of ongoing success by the tone. This process describes Biofeedback Guided imagery Therapeutic touch Assertiveness training

Biofeedback

Which approach to reducing patient stress is most effective in people with low to moderate hypnotic ability? Meditation Biofeedback Journal keeping Breathing exercises

Biofeedback

A nurse advises a stressed patient to perform meditation to decrease stress levels. How does meditation help in relieving stress? By creating a hypometabolic state of quieting the sympathetic nervous system. By allowing switching from the sympathetic mode to the parasympathetic mode. By dampening the cognitive processes likely to induce stress and anxiety reactions. By eliminating muscle contraction and decreasing the related anxiety levels.

By creating a hypometabolic state of quieting the sympathetic nervous system. Meditation helps to elicit relaxation by creating a hypometabolic state of quieting the sympathetic nervous system. A decreased activation of the sympathetic nervous system reduces the stress responses and promotes relaxation. A relaxation response allows switching from the sympathetic mode to the parasympathetic mode. Techniques like deep breathing exercises help to dampen the cognitive processes likely to induce stress and anxiety reactions. Progressive muscle relaxation helps to eliminate muscle contraction and decrease the related anxiety levels. p. 166

Which assessment monitors the effect of stress attributed to the stimulation of the hypothalamus-pituitary-adrenal cortex? Heart Rate Triglycerides Blood Glucose Level Brain norepinephrine

Blood glucose levels An increase in gluconeogenesis, stimulated by the release of cortisol, ensures that increased amounts of glucose are available to the individual. Increased glucose levels heighten and maintain energy levels to meet the demands of a crisis or stressor. None of the other options are as directly associated with the hypothalamus-pituitary-adrenal cortex.

A patient discloses several concerns and associated feelings. If the nurse wants to seek clarification, which comment would be appropriate? a. "What are the common elements here?" b. "Tell me again about your experiences." c. "Am I correct in understanding that." d. "Tell me everything from the beginning."

C Asking, "Am I correct in understanding that ..." permits clarification to ensure that both the nurse and patient share mutual understanding of the communication. Asking about common elements encourages comparison rather than clarification. The remaining responses are implied questions that suggest the nurse was not listening.

A patient tells the nurse, "I don't think I'll ever get out of here." Select the nurse's most therapeutic response. a. "Don't talk that way. Of course you will leave here!" b. "Keep up the good work, and you certainly will." c. "You don't think you're making progress?" d. "Everyone feels that way sometimes."

C By asking if the patient does not believe that progress has been made, the nurse is reflecting or paraphrasing by putting into words what the patient is hinting. By making communication more explicit, issues are easier to identify and resolve. The remaining options are nontherapeutic techniques. Telling the patient not to "talk that way" is disapproving. Saying that everyone feels that way at times minimizes feelings. Telling the patient that good work will always result in success is falsely reassuring.

Operant conditioning is part of the treatment plan to encourage speech in a child who is nearly mute. Which technique applies? a. Encourage the child to observe others talking. b. Include the child in small group activities. c. Give the child a small treat for speaking. d. Teach the child relaxation techniques.

C Operant conditioning involves giving positive reinforcement for a desired behavior. Treats are rewards and reinforce speech through positive reinforcement.

A nurse consistently encourages patient to do his or her own activities of daily living. If the patient is unable to complete an activity, the nurse helps until the patient is once again independent. This nurse's practice is most influenced by which theorist? a. Betty Neuman b. Patricia Benner c. Dorothea Orem d. Joyce Travelbee

C Orem emphasizes the role of the nurse in promoting self-care activities of the patient, this has relevance to the seriously and persistently mentally ill patient.

A psychotherapist works with an anxious, dependent patient. Which strategy is most consistent with psychoanalytic psychotherapy? a. Identifying the patient's strengths and assets b. Praising the patient for describing feelings of isolation c. Focusing on feelings developed by the patient toward the therapist d. Providing psychoeducation and emphasizing medication adherence

C Positive or negative feelings of the patient toward the therapist indicate transference. Transference is a psychoanalytic concept that can be used to explore previously unresolved conflicts. The distracters relate to biological therapy and supportive psychotherapy. Use of psychoeducational materials is a common "homework" assignment used in cognitive therapy.

Which principle should guide the nurse in determining the extent of silence to use during patient interview sessions? a. A nurse is responsible for breaking silences. b. Patients withdraw if silences are prolonged. c. Silence can provide meaningful moments for reflection. d. Silence helps patients know that what they said was understood.

C Silence can be helpful to both participants by giving each an opportunity to contemplate what has transpired, weigh alternatives, and formulate ideas. A nurse breaking silences is not a principle related to silences. It is inaccurate to say that patients withdraw during long silences or that silence helps patients know that they are understood. Feedback helps patients know they have been understood.

A college student received an invitation to attend the wedding of a close friend who lives across the country. The student is afraid of flying. Which type of therapy would be most helpful for this patient? a. Psychoanalysis b. Aversion therapy c. Systematic desensitization d. Short-term dynamic therapy

C Systematic desensitization is a type of therapy aimed at extinguishing a specific behavior, such as the fear of flying. Psychoanalysis and short-term dynamic therapy seek to uncover conflicts. Aversion therapy involves use of a noxious stimulus, punishment, and avoidance.

A nurse presents a community education program about mental illness. Which comment by a participant best demonstrates a correct understanding of mental illness from a biological perspective? a. "Some people experience life events so traumatic that they cannot be overcome." b. "Disturbed and conflicted family relationships are usually a starting place for mental illness." c. "My friend has had bipolar disorder for years and many problems have resulted. It's not her fault." d. "Mental illness is the result of developmental complications that cause a person not to grow to their full potential."

C The correct response demonstrates an understanding that mental illness is physical in origin. The physical origins of mental illness are aspects of the biological model. The incorrect responses assign the origins of mental illness to interpersonal relationships and traumatic events.

An adult dies in a tragic accident. Afterward, the siblings plan a funeral service. Which statement by a sibling best indicates a sense of self-actualization? a. "Of all of us, I am the most experienced with planning these types of events." b. "Funerals are supposed to be conducted quietly, respectfully, and according to a social protocol." c. "This death was unfair but I hope we can plan a service that everyone feels is a celebration of life." d. "This death was probably the consequence of years of selfish and inconsiderate behavior by our sibling."

C The correct response shows an accurate perception of reality as well as a focus on solving the problem in a way that involves others. These factors are characteristic of self-actualization. The incorrect responses demonstrate self-centeredness, rigidity, and blaming which are characteristic of a failure to achieve self-actualization.

The parent of a 4-year-old rewards and praises the child for helping a sibling, being polite, and using good manners. These qualities are likely to be internalized and become part of which system of the personality? a. Id b. Ego c. Superego d. Preconscious

C The superego contains the "shoulds," or moral standards internalized from interactions with significant others. Praise fosters internalization of desirable behaviors. The id is the center of basic instinctual drives, and the ego is the mediator. The ego is the problem-solving and reality-testing portion of the personality that negotiates solutions with the outside world. The preconscious is a level of awareness from which material can be retrieved easily with conscious effort. This item relates to an audience response question.

An adult says, "I never know the answers," and "My opinion does not count." Which psychosocial crisis was unsuccessfully resolved for this adult? a. Initiative versus guilt b. Trust versus mistrust c. Autonomy versus shame and doubt d. Generativity versus self-absorption

C These statements show severe self-doubt, indicating that the crisis of gaining control over the environment was not met successfully. Unsuccessful resolution of the crisis of initiative versus guilt results in feelings of guilt. Unsuccessful resolution of the crisis of trust versus mistrust results in poor interpersonal relationships and suspicion of others. Unsuccessful resolution of the crisis of generativity versus self-absorption results in self-absorption that limits the ability to grow as a person.

Documentation in a patient's chart shows, "Throughout a 5-minute interaction, patient fidgeted and tapped left foot, periodically covered face with hands, and looked under chair while stating, 'I enjoy spending time with you.'" Which analysis is most accurate? a. The patient is giving positive feedback about the nurse's communication techniques. b. The nurse is viewing the patient's behavior through a cultural filter. c. The patient's verbal and nonverbal messages are incongruent. d. The patient is demonstrating psychotic behaviors.

C When a verbal message is not reinforced with nonverbal behavior, the message is confusing and incongruent. It is inaccurate to say that the patient is giving positive feedback about the nurse's communication techniques. The concept of a cultural filter is not relevant to the situation because a cultural filter determines what we will pay attention to and what we will ignore. Data are insufficient to draw the conclusion that the patient is demonstrating psychotic behaviors.

A suspicious client who smokes several packs of cigarettes daily and drinks large quantities of coffee and soda as he is able to afford reacts to every nursing intervention with sarcasm. When asking for advice, the nurse manager's most helpful response is a. "You are dealing with a very difficult and resistant client; just keep with your plan." b. "If you haven't been able to establish client trust by now, ask for a change of assignment." c. "Remember that sarcasm represents the oral-stage fixation of development." d. "You are attempting to work with a client who likes to keep others off-balance."

C Remember that sarcasm represents the oral-stage fixation of development

The nurse planning care for a 14-year-old needs to take into account that the developmental task of adolescence is to: a. establish trust. b. gain autonomy. c. achieve identity. d. develop a sense of industry.

C achieve identity

Morgan is a third-year nursing student in her psychiatric clinical rotation. She is assigned to an 80-year-old widow admitted for major depressive disorder. The patient describes many losses and sadness. Morgan becomes teary and says meaningfully, "I am so sorry for you." Morgan's instructor overhears the conversation and says, "I understand that getting tearful is a human response. Yet, sympathy isn't helpful in this field." The instructor urges Morgan to focus on: A) "Adopting the patient's sorrow as your own" B) "Maintaining pure objectivity" C) "Using empathy to demonstrate respect and validation of the patient's feelings" D) "Using touch to let her know that everything is going to be alright"

C) "Using empathy to demonstrate respect and validation of the patient's feelings"

A registered nurse is caring for an older male who reports depressive symptoms since his wife of 54 years died suddenly. He cries, maintains closed body posture, and avoids eye contact. Which nursing action describes attending behavior? A) Reminding the patient gently that he will "feel better over time" B) Using a soft tone of voice or questioning C) Sitting with the patient and taking cures for when to talk or when to remain silent D) Offering medication and bereavement services

C) Sitting with the patient and taking cures for when to talk or when to remain silent

Which comments by a nurse demonstrate use of therapeutic communication techniques? (Select all that apply.) a. "Why do you think these events have happened to you?" b. "There are people with problems much worse than yours." c. "I'm glad you were able to tell me how you felt about your loss." d. "I noticed your hands trembling when you told me about your accident." e. "You look very nice today. I'm proud you took more time with your appearance."

C, D The correct responses demonstrate use of the therapeutic techniques making an observation and showing empathy. The incorrect responses demonstrate minimizing feelings, probing, and giving approval, which are nontherapeutic techniques.

A client is displaying symptomatology reflective of a panic attack. In order to help the client regain control, the nurse responds: A. "You need to calm yourself." B. "What is it that you would like me to do to help you?" C. "Can you tell me what you were feeling just before your attack?" D. "I will get you some medication to help calm you."

C. "Can you tell me what you were feeling just before your attack?" A response that helps the client identify the precipitant stressor is most therapeutic.

Which nursing diagnosis would be most useful for clients with anxiety disorders? A. Excess fluid volume B. Disturbed body image C. Ineffective role performance D. Disturbed personal identity

C. Ineffective role performance Anxiety disorders often interfere with the usual role performance of clients. Consider the client with agoraphobia who cannot go to work, or the client with obsessive-compulsive disorder who devotes time to the ritual rather than to parenting.

The plan of care for a client who has elaborate washing rituals specifies that response prevention is to be used. Which scenario is an example of response prevention? A. Having the client repeatedly touch "dirty" objects B. Not allowing the client to seek reassurance from staff C. Not allowing the client to wash hands after touching a "dirty" object D. Telling the client that he or she must relax whenever tension mounts

C. Not allowing the client to wash hands after touching a "dirty" object Response prevention is a technique by which the client is prevented from engaging in the compulsive ritual. A form of behavior therapy, response prevention is never undertaken without physician approval.

Lana is out of surgery and on the medical-surgical unit for recovery. You visit her the day after her surgical procedure. While you are in the room, Lana becomes visibly anxious and short of breath, and she states, "I feel so anxious! Something is wrong!" Your best action is to: A. reassure Lana that she is experiencing normal anxiety and do deep breathing exercises with her. B. use the call light to inquire whether Lana has any prn anxiety medication. C. call for help and assess Lana's vital signs. D. tell Lana you will stay with her until the anxiety subsides.

C. call for help and assess Lana's vital signs. In anxiety caused by a medical condition, the individual's symptoms of anxiety are a direct physiological result of a medical condition, such as hyperthyroidism, pulmonary embolism, or cardiac dysrhythmias. In this case Lana is postoperative and could be experiencing a pulmonary embolism, as evidenced by the shortness of breath and anxiety. She needs immediate evaluation for any serious medical condition. The other options would all be appropriate after it has been determined that no serious medical condition is causing the anxiety.

A Gulf War veteran is entering treatment for post-traumatic stress disorder. An important facet of assessment is to: A. ascertain how long ago the trauma occurred. B. find out if the client uses acting-out behavior. C. determine use of chemical substances for anxiety relief. D. establish whether the client has chronic hypertension related to high anxiety.

C. determine use of chemical substances for anxiety relief. Substance abuse often coexists with post-traumatic stress disorder. It is often the client's way of self-medicating to gain relief of symptoms.

Panic attacks in Latin American individuals often involve: A. repetitive involuntary actions. B. blushing. C. fear of dying. D. offensive verbalizations.

C. fear of dying. Panic attacks in Latin Americans and Northern Europeans often involve sensations of choking, smothering, numbness or tingling, as well as fear of dying.

If a client's record mentions that the client habitually relies on rationalization, the nurse might expect the client to: A. make jokes to relieve tension. B. miss appointments. C. justify illogical ideas and feelings. D. behave in ways that are the opposite of his or her feelings.

C. justify illogical ideas and feelings. Rationalization involves justifying illogical or unreasonable ideas or feelings by developing logical explanations that satisfy the teller and the listener.

A young adult applying for a position is mildly tense but eager to begin the interview. This can be assessed as showing: A. denial. B. compensation. C. normal anxiety. D. selective inattention.

C. normal anxiety. Normal anxiety is a healthy life force needed to carry out the tasks of living and striving toward goals. It prompts constructive actions.

A person who recently gave up smoking and now talks constantly about how smoking fouls the air, causes cancer, and "burns" money that could be better spent to feed the poor is demonstrating: A. projection. B. rationalization. C. reaction formation. D. undoing.

C. reaction formation. Reaction formation keeps unacceptable feelings or behaviors out of awareness by developing the opposite behavior or emotion.

A client frantically reports to the nurse that "You have got to help me! Something terrible is happening. I can't think. My heart is pounding, and my head is throbbing." The nurse should assess the client's level of anxiety as: A. mild. B. moderate. C. severe. D. panic.

C. severe. Severe anxiety is characterized by feelings of falling apart and impending doom, impaired cognition, and severe somatic symptoms such as headache and pounding heart.

When prescribed lorazepam (Ativan) 1 mg po qid for 1 week for generalized anxiety disorder, the nurse should: A. question the physician's order because the dose is excessive. B. explain the long-term nature of benzodiazepine therapy. C. teach the client to limit caffeine intake. D. tell the client to expect mild insomnia.

C. teach the client to limit caffeine intake. Caffeine is an antagonist of antianxiety medication.

A nurse teaches a patient a technique for examining negative thoughts and restating them in positive ways. This technique is called Guided imagery Wishful thinking Cognitive reframing Confrontational assertion

Cognitive reframing cognitive reframing calls for changing the viewpoint of a situation and replacing it with another viewpoint that fits the facts but is less negative

A nurse teaches a client a technique for examining negative thoughts and restraining them in positive ways. What term is used to identify this technique? Guided imagery Cognitive reframing wishful thinking confrontational assertion

Cognitive reframing Cognitive reframing calls for changing the viewpoint of a situation and replacing it with another viewpoint that fits the facts but is less negative. That description does not apply to any of the other options.

As a result of Harry Stack Sullivan's work, the mental health nurse is involved in providing clients with a. security operations. b. psychoanalysis. c. analysis of behavior patterns. d. a psychotherapeutic environment.

D a psychotherapeutic environment

A nurse interacts with a newly hospitalized patient. Select the nurse's comment that applies the communication technique of "offering self." a. "I've also had traumatic life experiences. Maybe it would help if I told you about them." b. "Why do you think you had so much difficulty adjusting to this change in your life?" c. "I hope you will feel better after getting accustomed to how this unit operates." d. "I'd like to sit with you for a while to help you get comfortable talking to me."

D "Offering self" is a technique that should be used in the orientation phase of the nurse-patient relationship. Sitting with the patient, an example of "offering self," helps to build trust and convey that the nurse cares about the patient. Two incorrect responses are ineffective and nontherapeutic. The other incorrect response is therapeutic but is an example of "offering hope."

A nurse listens to a group of recent retirees. One says, "I volunteer with Meals on Wheels, coach teen sports, and do church visitation." Another laughs and says, "I'm too busy taking care of myself to volunteer to help others." Which psychosocial developmental task do these statements contrast? a. Trust and mistrust b. Intimacy and isolation c. Industry and inferiority d. Generativity and self-absorption

D Both retirees are in middle adulthood, when the developmental crisis to be resolved is generativity versus self-absorption. One exemplifies generativity the other embodies self-absorption.

A patient expresses a desire to be cared for by others and often behaves in a helpless fashion. Which stage of psychosexual development is most relevant to the patient's needs? a. Latency b. Phallic c. Anal d. Oral

D Fixation at the oral stage sometimes produces dependent infantile behaviors in adults. Latency fixations often result in difficulty identifying with others and developing social skills, resulting in a sense of inadequacy and inferiority. Phallic fixations result in having difficulty with authority figures and poor sexual identity. Anal fixation sometimes results in retentiveness, rigidity, messiness, destructiveness, and cruelty. This item relates to an audience response question.

A person says, "I was the only survivor in a small plane crash. Three business associates died. I got depressed and saw a counselor twice a week for 4 weeks. We talked about my feelings related to being a survivor, and I'm better now." Which type of therapy was used? a. Systematic desensitization b. Psychoanalysis c. Behavior modification d. Interpersonal psychotherapy

D Interpersonal psychotherapy returned the patient to his former level of functioning by helping him come to terms with the loss of friends and guilt over being a survivor. Systematic desensitization is a type of therapy aimed at extinguishing a specific behavior, such as the fear of flying. Psychoanalysis would call for a long period of exploration of unconscious material. Behavior modification would focus on changing a behavior rather than helping the patient understand what is going on in his life.

A Puerto Rican American patient uses dramatic body language when describing emotional discomfort. Which analysis most likely explains the patient's behavior? The patient a. has a histrionic personality disorder. b. believes dramatic body language is sexually appealing. c. wishes to impress staff with the degree of emotional pain. d. belongs to a culture in which dramatic body language is the norm.

D Members of Hispanic American subcultures tend to use high affect and dramatic body language as they communicate. The other options are more remote possibilities.

A nurse wants to find information on current evidence-based research, programs, and practices regarding mental illness and addictions. Which resource should the nurse consult? a. American Psychiatric Association b. American Psychological Association (APA) c. Clinician's Quick Guide to Interpersonal Psychotherapy d. Substance Abuse and Mental Health Services Administration (SAMHSA)

D The SAMHSA maintains a National Registry of Evidence-based Practices and Programs. New therapies are entered into the database on a regular basis. The incorrect responses are resources but do not focus on evidence-based information.

A Filipino American patient had a nursing diagnosis of situational low self-esteem related to poor social skills as evidenced by lack of eye contact. Interventions were applied to increase the patient's self-esteem but after 3 weeks, the patient's eye contact did not improve. What is the most accurate analysis of this scenario? a. The patient's eye contact should have been directly addressed by role playing to increase comfort with eye contact. b. The nurse should not have independently embarked on assessment, diagnosis, and planning for this patient. c. The patient's poor eye contact is indicative of anger and hostility that were unaddressed. d. The nurse should have assessed the patient's culture before making this diagnosis and plan.

D The amount of eye contact a person engages in is often culturally determined. In some cultures, eye contact is considered insolent, whereas in others eye contact is expected. Asian Americans, including persons from the Philippines, often prefer not to engage in direct eye contact.

A school age child tells the school nurse, "Other kids call me mean names and will not sit with me at lunch. Nobody likes me." Select the nurse's most therapeutic response. a. "Just ignore them and they will leave you alone." b. "You should make friends with other children." c. "Call them names if they do that to you." d. "Tell me more about how you feel."

D The correct response uses exploring, a therapeutic technique. The distracters give advice, a nontherapeutic technique.

A 26-month-old displays negative behavior, refuses toilet training, and often says, "No!" Which psychosocial crisis is evident? a. Trust versus mistrust b. Initiative versus guilt c. Industry versus inferiority d. Autonomy versus shame and doubt

D The crisis of autonomy versus shame and doubt relates to the developmental task of gaining control of self and environment, as exemplified by toilet training. This psychosocial crisis occurs during the period of early childhood. Trust versus mistrust is the crisis of the infant. Initiative versus guilt is the crisis of the preschool and early-school-aged child. Industry versus inferiority is the crisis of the 6- to 12-year-old child.

A nurse supports a parent for praising a child who behaves in helpful ways to others. When this child behaves with politeness and helpfulness in adulthood, which feeling will most likely result? a. Guilt b. Anxiety c. Humility d. Self-esteem

D The individual will be living up to the ego ideal, which will result in positive feelings about self. The other options are incorrect because each represents a negative feeling.

Which comment best indicates a patient is self-actualized? a. "I have succeeded despite a world filled with evil." b. "I have a plan for my life. If I follow it, everything will be fine." c. "I'm successful because I work hard. No one has ever given me anything." d. "My favorite leisure is walking on the beach, hearing soft sounds of rolling waves."

D The self-actualized personality is associated with high productivity and enjoyment of life. Self-actualized persons experience pleasure in being alone and an ability to reflect on events.

A patient says to the nurse, "I dreamed I was stoned. When I woke up, I felt emotionally drained, as though I hadn't rested well." Which response should the nurse use to clarify the patient's comment? a. "It sounds as though you were uncomfortable with the content of your dream." b. "I understand what you're saying. Bad dreams leave me feeling tired, too." c. "So you feel as though you did not get enough quality sleep last night?" d. "Can you give me an example of what you mean by 'stoned'?"

D The technique of clarification is therapeutic and helps the nurse examine the meaning of the patient's statement. Asking for a definition of "stoned" directly asks for clarification. Restating that the patient is uncomfortable with the dream's content is parroting, a nontherapeutic technique. The other responses fail to clarify the meaning of the patient's comment.

During an interview, a patient attempts to shift the focus from self to the nurse by asking personal questions. The nurse should respond by saying: a. "Why do you keep asking about me?" b. "Nurses direct the interviews with patients." c. "Do not ask questions about my personal life." d. "The time we spend together is to discuss your concerns."

D When a patient tries to focus on the nurse, the nurse should refocus the discussion back onto the patient. Telling the patient that interview time should be used to discuss patient concerns refocuses discussion in a neutral way. Telling patients not to ask about the nurse's personal life shows indignation. Saying that nurses prefer to direct the interview reflects superiority. "Why" questions are probing and nontherapeutic.

The nurse providing anticipatory guidance to the mother of a toddler should advise that childhood temper tantrums are best handled by a. giving the child what he is asking for. b. scolding the child when he displays tantrum behaviors. c. spanking the child at the onset of the tantrum behaviors. d. ignoring the tantrum and giving attention when the child acts appropriately.

D ignoring the tantrum and giving attention when the child acts appropriately

Which client problem would be most suited to the use of interpersonal therapy? a. Disturbed sensory perception b. Impaired social interaction c. Medication noncompliance d. Dysfunctional grieving

D Dysfunctional grieving

What is the greatest trigger for the development of a patient's nurse focused transference? A) The similarity between the nurse and someone the patient already dislikes B) The nature of the patient's diagnosed mental illness C) The history the patient has with their parents D) The degree of authority the nurse has over the patient

D) The degree of authority the nurse has over the patient

Which therapies involve electrical brain stimulation for treatment of mental illness? (Select all that apply.) a. Aversion therapy b. Operant conditioning c. Systematic desensitization d. Electroconvulsive therapy (ECT) e. Transcranial magnetic stimulation (TMS)

D, E ECT and TMS are therapies that use electrical stimulation of the brain as a form of treatment for mental illness. The incorrect responses are therapies that are interpersonal in nature.

Which medication is FDA approved for treatment of anxiety in children? A. Lorazepam (benzodiazepine) B. Fluoxetine (selective serotonin reuptake inhibitor) C. Clomipramine (tricyclic antidepressant) D. None of the above

D. None of the above There are no medications with FDA approval for children with anxiety disorders; however, medications approved for other age groups are often prescribed. None of the other options are FDA approved to treat anxiety in children (see the previous sentence).

Which behavior would be characteristic of an individual who is displacing anger? A. Lying B. Stealing C. Slapping D. Procrastinating

D. Procrastinating A passive-aggressive person deals with emotional conflict by indirectly and unassertively expressing aggression toward others. Procrastination is an expression of resistance.

Which nursing intervention would be helpful when caring for a client diagnosed with an anxiety disorder? A. Express mild amusement over symptoms. B. Arrange for client to spend time away from others. C. Advise client to minimize exercise to conserve endorphins. D. Reinforce use of positive self-talk to change negative assumptions.

D. Reinforce use of positive self-talk to change negative assumptions. This technique is a variant of cognitive restructuring. "I can't do that" is changed to "I can do it if I try."

The nurse caring for a client experiencing a panic attack anticipates that the psychiatrist would order a stat dose of: A. standard antipsychotic medication. B. tricyclic antidepressant medication. C. anticholinergic medication. D. a short-acting benzodiazepine medication.

D. a short-acting benzodiazepine medication. A short-acting benzodiazepine is the only type of medication listed that would lessen the client's symptoms of anxiety within a few minutes. Anticholinergics do not lower anxiety; tricyclic antidepressants have very little antianxiety effect and have a slow onset of action; and a standard antipsychotic medication will lower anxiety but has a slower onset of action and the potential for more side effects.

Working to help the client view an occurrence in a more positive light is called: A. flooding. B. desensitization. C. response prevention. D. cognitive restructuring.

D. cognitive restructuring. The purpose of cognitive restructuring is to change the individual's negative view of an event or a situation to a view that remains consistent with the facts but that is more positive.

The primary purpose of performing a physical examination before beginning treatment for any anxiety disorder is to: A. protect the nurse legally. B. establish the nursing diagnoses of priority. C. obtain information about the client's psychosocial background. D. determine whether the anxiety is primary or secondary in origin.

D. determine whether the anxiety is primary or secondary in origin. The symptoms of anxiety can be caused by a number of physical disorders or are said to be caused by an underlying physical disorder. The treatment for secondary anxiety is treatment of the underlying cause.

A symptom commonly associated with panic attacks is: A. obsessions. B. apathy. C. fever. D. fear of impending doom.

D. fear of impending doom. The feelings of terror present during a panic attack are so severe that normal function is suspended, the perceptual field is severely limited, and misinterpretation of reality may occur.

The major distinction between fear and anxiety is that fear: A. is a universal experience; anxiety is neurotic. B. enables constructive action; anxiety is dysfunctional. C. is a psychological experience; anxiety is a physiological experience. D. is a response to a specific danger; anxiety is a response to an unknown danger.

D. is a response to a specific danger; anxiety is a response to an unknown danger. Fear is a response to an objective danger; anxiety is a response to a subjective danger.

You are providing teaching to Lana, a preoperative patient just before surgery. She is becoming more and more anxious as you talk. She begins to complain of dizziness and heart pounding, and she is trembling. She seems confused. Your best response is to: A. reinforce the preoperative teaching by restating it slowly. B. have Lana read the teaching materials instead of verbal instruction. C. have a family member read the preoperative materials to Lana. D. not attempt any teaching at this time.

D. not attempt any teaching at this time. Patients experiencing severe anxiety, as the symptoms suggest, are unable to learn or solve problems. The other options would not be effective because you are still attempting to teach someone who has a severe level of anxiety.

Delusionary thinking is a characteristic of: A. chronic anxiety. B. acute anxiety. C. severe anxiety. D. panic level anxiety.

D. panic level anxiety. Panic level anxiety is the most extreme level and results in markedly disturbed thinking.

A client is running from chair to chair in the solarium. He is wide-eyed and keeps repeating, "They are coming! They are coming!" He neither follows staff direction nor responds to verbal efforts to calm him. The level of anxiety can be assessed as: A. mild. B. moderate. C. severe. D. panic.

D. panic. Panic-level anxiety results in markedly disorganized, disturbed behavior, including confusion, shouting, and hallucinating. Individuals may be unable to follow directions and may need external limits to ensure safety.

An effective stress-reduction technique a nurse might teach an individual with performance anxiety is Assertiveness Journal keeping Deep breathing Restructuring and setting priorities

Deep breathing

Elaine is a 62-year-old patient who is recovering from a urinary tract infection during which she was hospitalized with delirium. She is following up with her primary care provider 4 weeks after being discharged. Based on research regarding possible postdelirium complications, what are important areas for the provider to assess at this time? Sleeping habits Sexual functioning Symptoms of posttraumatic stress Depression and level of cognition

Depression and level of cognition Although delirium is usually a short-term condition, it may have long-term consequences. In patients with preexisting cognitive impairment, there is an acceleration of cognitive decline. Although there are reports of long-term cognitive impairment (in the absence of preexisting cognitive impairment) and functional decline following delirium, results of studies have been inconsistent. An association also exists with depression after delirium. Although a holistic examination would assess sleep, this is not the area that research has found to be problematic. A holistic examination would include sexual functioning, but it is not the priority at this time. Posttraumatic stress symptoms have been seen in younger patients who experienced delirium while hospitalized.Cognitive Level: Analyze (Analysis)Nursing Process: AssessmentNCLEX: Psychosocial IntegrityText page: 432

When should a nurse be most alert to the possibility of communication errors resulting in harm to the patient? a. Change of shift report b. Admission interviews c. One-to-one conversations with patients d. Conversations with patient families

a. Change of shift report

All of the following are positive aspects of journaling EXCEPT: Ease worry and obsession Increase energy levels Facilitate the grieving process Distracting you from daily activities

Distracting you from daily activities

What is the psychological state that results in anxiety, depression, confusion, helplessness, hopelessness, and fatigue? Distress Eustress Fight-or-flight response General adaption syndrome

Distress Distress is the result of a negative perception toward a stressor such as a death in the family, financial overload, and school or work demands. Eustress is a positive, beneficial energy that motivates and results in feelings of happiness, hopefulness, and purposeful movement. Fight-or-flight response is a pathway of the response to stress. General adaption syndrome is a theory that shows that different types of stressors bring about different patterns of responses and that it is the degree of stress that is important. p. 159

An important difference between the developmental theories of Freud and Erikson is ...

Erikson viewed individual growth in terms of social setting.

One effect of stress can be attributed to the stimulation of the hypothalamus-pituitary-adrenal cortex, causing a short-term increase in Heart rate Triglycerides Gluconeogenesis Brain norepinephrine

Gluconeogenesis

Which interventions will the nurse include in the plan of care of a patient diagnosed with generalized anxiety syndrome (GAS) resulting from stress? Select all that apply. Getting up 30 minutes later each morning. Going to sleep 30 minutes earlier than usual. Listening to soothing music to increase relaxation. Including 30 minutes of exercise into your daily routine three days a week. Including some form of exercise about 30 minutes before going to bed.

Going to sleep 30 minutes earlier than usual. Listening to soothing music to increase relaxation. Including 30 minutes of exercise into your daily routine three days a week.

What is the rationale for providing a patient diagnosed with dementia easily accessible finger foods throughout the day a) Increases input throughout the day b) The person may be anorexic c) Assists with monitoring food intake d) Helps prevent constipation

Increases input throughout the day

What would a client experience during a progressive relaxation session? - instruction in sequential tensing and relaxing of various muscle groups until the entire body is relaxed - being attached to a machine that monitors a physical parameter and receiving audible feedback about the state of that parameter - having a nurse enter the client's energy field to rebalance it and bring harmony - being led into a positive imaginary sensory experience

Instruction in sequential tensing and relaxing of various muscle groups until the entire body is relaxed Instruction on sequential tensing and relaxing muscles provides a description of Benson's method of progressive relaxation. Being attached to a machine that uses sound describes biofeedback. Rebalancing an energy field describes therapeutic touch. Positive imaging describes a component of guided imagery

Stress can be attributed to stimulation of the hypothalamus-pituitary-adrenal cortex. Which assessment finding would confirm the long-term effects of such stress? select all that apply Insulin resistance A high resting heart rate Digestive problems Chronic muscle tension Obesity

Insulin Resistance Obesity Insulin resistance and obesity are considered long-term sequelae of the high blood glucose levels incurred when the body responds to stress. None of the other options are related to the hypothalamus-pituitary-adrenal cortex

A client with a history of three failed engagements is concerned about being "too possessive." This concern supports a need for which type of therapy?

Interpersonal

What tool should the nurse use in assessing the amount of stress a client has experienced in the past year? NANDA handbook DSM-IV-TR Quick Mental Status Assessment Life-Changing Event Questionnaire

Life-Changing Event Questionnaire This questionnaire calls for the client to review events of the past year and score each. This is the only tool listed that assesses stress

Over a 5-year period, an adult experienced liver failure. A liver transplant was performed. During the immediate postoperative period, which intervention could the nurse recommend to enhance healing and reduce the harmful effects of stress? Aerobic exercise Listening to music Attending a support group Occasional chocolate treats

Listening to music

Based on current research, which of the following patients is most likely to develop dementia? Karen, who works as an office manager in a high-stress environment Milo, who is a former boxer and is now a trainer Lilly, who works in a factory where asbestos is found Justin, who is a bartender in a dark underground club/bar

Milo, who is a former boxer and is now a trainer Brain injury and trauma are associated with a greater risk of developing Alzheimer's disease and other dementias. People who suffer repeated head trauma, such as boxers and football players, may be at greater risk. The other options do not specifically represent known risk.Cognitive Level: Apply (Application)Nursing Process: DiagnosisNCLEX: Psychosocial IntegrityText page: 438

Your 39-year-old patient, Samantha, who was admitted with anxiety, asks you what the stress-relieving technique of mindfulness is. The best response is: Mindfulness is focusing on an object and repeating a word or phrase while deep breathing Mindfulness is progressively tensing, then relaxing, body muscles Mindfulness is focusing on the here and now, not the past or future, and paying attention to what is going on around you Mindfulness is a memory system to assist you in short-term memory recall

Mindfulness is focusing on the here and now, not the past or future, and paying attention to what is going on around you

When considering the pathophysiology responsible for both delirium and dementia, which intervention is appropriate for delirium specifically a) Assist with needs related to nutrition, elimination, hydration and personal hygiene b) Monitor neurological status on an ongoing basis c) Place ID bracelet on patient d) Give one simple direction at a time in a respectful tone of voice

Monitor neurological status on an ongoing basis

Which physiologic responses are associated with severe long-term stress? Select all that apply. Obesity Hypotension Atherosclerosis Protein breakdown Stimulation of the immune system

Obesity Atherosclerosis Protein breakdown

The relaxation response calls upon the initiation of what process? Sympathetic activation Parasympathetic activation Brainstem deactivation Increased cortisol production by the adrenals

Parasympathetic activation Sympathetic activation prepares the individual for the fight-or-flight response. Parasympathetic activation has the opposite effect. None of the other options would bring about relaxation

Jacob is a college student whose friend recently committed suicide. Jacob rates his stress as low. Melissa was also friend with the person who committed suicide, but she rates her stress as high. The difference in how Jacob and Melissa rate their stress may be explained by which coping mechanism? projection denial perception repression

Perception Perception, which is influenced by gender, culture, age, and life experience, plays a part in how someone will respond to a stress. The perception of a stressor determines the person's emotional and psychological reactions to it. The other options are all defense mechanisms that do not explain the difference in reactions to a stressor.

Claire is a student nurse working with Carl, an 82-year-old patient with dementia. She finds herself frustrated at times by not knowing how best to care for or communicate with Carl. Which of the following statements she could make to Carl illustrates best care practice? Lighthearted banter: "Carl, you look great today in your new sweater, you handsome devil!" Limit setting: "Carl, you cannot yell out in your room. You are upsetting other patients." Firm direction: "You will take a shower this morning; there is no debating about it so don't try to argue." Positive regard: "Carl, I am glad to be here caring for you today. Let's talk about your plans for the day."

Positive regard: "Carl, I am glad to be here caring for you today. Let's talk about your plans for the day." Positive regard implies respect. It is the ability to view another person as being worthy of caring about and as someone who has strengths. The attitude of unconditional positive regard is the nurse's single most effective tool in caring for people with dementia. It induces people to cooperate with care and increases family members' satisfaction with care. Although the patient may not be able to verbalize plans for his day, this response conveys belief that the patient has something to offer and treats him with respect. It also shows that the nurse wants to care for the patient and conveys commitment to the relationship. Limit-setting may be necessary at times; however it is not the most effective care tool. The other responses are nontherapeutic.Cognitive Level: Apply (Application)Nursing Process: ImplementationNCLEX: Psychosocial IntegrityText page: 442

The term "perceptual disturbance" refers to difficulty in which area of function a) Processing information about one's internal and external environment b) Can be one's way of thinking to accommodate new info c) Performing purposeful motor movement d) Formulating words appropriately

Processing information about one's internal and external environment

What is the usual progression of Alzheimer's disease? A single, short episode followed by years of normal function Recurring remissions and exacerbations Progressive deterioration There is no usual progression

Progressive deterioration The usual progression of Alzheimer's disease is steadily downward.REF: 438

Biofeedback allows someone to manage stress through which of the following methods? Focusing on taking slow deep and even breaths Using positive images to replace negative or stressful feelings Provides immediate and exact information regarding muscle activity, brain waves, skin temperature, heart rate, blood pressure and other bodily functions Training the mind to develop a great calm and insight into ones experience

Provides immediate and exact information regarding muscle activity, brain waves, skin temperature, heart rate, blood pressure and other bodily functions

The nurse is conducting group therapy for geriatric patients. The nurse gives instructions to the patients, "Close your eyes and imagine a peaceful scene, you are very comfortable, nothing is there to disturb you." What feedback given by the patients after the therapy indicates effective therapy? The patients Report relief from pain Are able to remain calm and silent Are able to acknowledge their feelings Are able to empathize with their peers

Report relief from pain

8. In an outpatient psychiatric clinic, a nurse notices that a newly admitted young male patient smiles when he sees her. One day the young man tells the nurse, "You are pretty like my mother." The nurse recognizes that the male is exhibiting: a. Transference b. Id expression c. Countertransference d. A cognitive distortion

a

Which neurotransmitter is a brain catecholamine that plays an important role in mood, sleep, sexuality, appetite, and metabolism? GABA Serotonin Glutamate Dopamine

Serotonin

Which statement made by a family member tends to support a diagnosis of delirium rather than dementia a) She was fine last night but this morning she was confused b) Dad doesn't seem to recognize us anymore c) She's convinced that snakes come into her room at night d) He can't remember when to take his pills or whether he's bathed

She was fine last night but this morning she was confused

What is the term used to describe the psychological or physical stimuli that are incompatible with the current functioning of an individual and require adaptation in the human body? Endorphins Cytokines Stressors Hormones

Stressors

Which nursing assessments are directed at monitoring a patient's fight or flight response? select all that apply blood pressure heart rate respiratory rate abdominal pain dilated pupils

blood pressure heart rate respiratory rate dilated pupils

A client, whose friend recently committed suicide, asks the nurse about some ways to help cope with the stress regarding the event. Which option should the nurse discuss with the client? - isolation for a short time so that the pain isn't reinforced by explaining her feelings over and over - Antianxiety medication to help her relax - Starting a hobby to keep her mind off the troubling event - Talking with friends and attending a loss support group

Talking with friends and attending a loss support group Social supports and support groups are two effective ways to cope with stress and stressful events. Isolation is never a healthy option; talking about feelings usually decreases stress, not increases. There is no evidence to suggest Melissa is anxious. Trying to "keep her mind off" the stressor does not develop coping mechanisms to deal with stress but rather encourages not dealing with the problem

Which statement best clarifies the difference between the art and the science of nursing?

The art is the care, compassion, and advocacy component, and the science is the applied knowledge base.

The nurse is caring for a 35-year-old female patient who reports occasional panic attacks, fatigue, and amenorrhea. What can the nurse infer about this patient? The patient has acute stress. The patient has chronic stress. The patient has a normal response to stress. The patient has a fight-or-flight reaction to stress.

The patient has chronic stress.

A patient scheduled for surgery seems to be anxious. The nurse teaches the patient to practice deep breathing exercises. What is the most appropriate reason for teaching deep breathing exercises to the patient? To help the patient prevent postoperative complications. To prevent preoperative risk of respiratory complications. To dampen the cognitive process involved in anxiety reactions. To promote lung expansion during administration of anesthesia.

To dampen the cognitive process involved in anxiety reactions.

Which statement made by the primary caregiver of a patient diagnosed with dementia demonstrates accurate understanding of providing the patient with a safe environment a) The local police know that he has wandered off before b) I keep the noise level low in the house c) We've installed locks on all the outside doors d) Our telephone number is always attached to the inside of his shirt pocket

We've installed locks on all the outside doors

Which event would a client with early stage 4 Alzheimer's disease have greatest difficulty remembering? His or her high school graduation The births of his or her children The story of a teenage escapade What he or she ate for breakfast

What he or she ate for breakfast Initially, recent memory is impaired, and remote memory remains intact.REF: 440; Table 23-3

The nurse is expected to perform an assessment of a client suspected to be in the earliest stage of Alzheimer's disease. What finding would be out of character if the client truly has stage 2 Alzheimer's disease? (Select all that apply) Willingness to respond directly to questions posed by nurse Charming behavior designed to hide memory deficit Confabulation to compensate for forgotten information Avoidance of questions by subject changing

Willingness to respond directly to questions posed by nurse During stage 1 Alzheimer's disease the client is aware of memory impairment and may attempt to disguise it or cover it by being evasive or using confabulation.REF: Page 440 (Table 23-3)

Which of these exercise techniques can reduce stress? Select all that apply: Yoga Tai chi Karate Dancing Aerobic

Yoga Tai chi Dancing Aerobic

During an admission assessment and interview, which channels of information communication should the nurse be monitoring? Select all that apply. a. Auditory b. Visual c. Written d. Tactile e. Olfactory

a. Auditory b. Visual d. Tactile e. Olfactory

Dementia in an older adult is often a misdiagnosis for depression. cerebral emboli. normal effects of aging. poor nutritional status.

depression. Depression in an older adult is frequently confused with dementia.REF: Page 438

A woman anticipating her wedding ceremony in a week comes to the Urgent Care Clinic with a headache that has been ongoing for three days duration as well as a pounding feeling in her chest. She is concerned that she may be having a stroke or a cerebral vascular accident (CVA). All medical tests are negative. The woman wonders what is happening to her because she feels she is unable to function. What is the best response to her question? You are having difficulty coping with your upcoming wedding. You are experiencing distress because of your upcoming wedding. You are experiencing eustress because of your upcoming wedding. You are being warned by your body that you may have hypertension.

You are having difficulty coping with your upcoming wedding.

1. A male patient reports to the nurse, "I'm told I have memories of childhood abuse stored in my unconscious mind. I want to work on this." Based on this statement, what information should the nurse provide the patient? a. To seek the help of a trained therapist to help uncover and deal with the trauma associated with those memories. b. How to use a defense mechanism such as suppression so that the memories will be less threatening. c. Psychodynamic therapy will allow the surfacing of those unconscious memories to occur in just a few sessions. d. Group sessions are valuable to identify underlying themes of the memories being suppressed.

a

Which client behavior illustrates eustress? a college student fails an exam a bride is planning for her wedding a man is laid off from his job an adolescent gets into a fight at school

a bribe is planning for her wedding Eustress is the result of a positive perception toward a stressor, such as having a baby, planning a wedding, or getting a new job. The other options all describe distress, or a negative energy.

3. When discussing therapy options, the nurse should provide information about interpersonal therapy to which patient? Select all that apply. a. The teenager who is the focus of bullying at school b. The older woman who has just lost her life partner to cancer c. The young adult who has begun demonstrating hoarding tendencies d. The adolescent demonstrating aggressive verbal and physical tendencies e. The middle-aged adult who recently discovered her partner has been unfaithful

a, b, e

Nurses caring for patients who have neurocognitive disorders are exposed to stress on many levels, specialized skills training and continuing education are helpful to diffuse nursing stress as well as SATA a) Expressing emotions by journaling b) Describing stressful events on Facebook c) Engage in exercise and relaxation activities d) Having realistic patient expectations e) Happy hour after work to blow off steam

a, c, d

What side effects should the nurse monitor for when caring for a patient prescribed donepezil SATA a) Insomnia b) Constipation c) Bradycardia d) Signs of dizziness e) Reports of headache

a, c, d, e

Stress can be attributed to stimulation of the hypothalamus-pituitary-adrenal cortex, and over the long term it can result in a. Insulin resistance b. Digestive problems c. Chronic muscle tension d. A high resting heart rate

a. Insulin resistance and obesity are considered long-term sequelae of the high blood glucose levels incurred when the body responds to stress. pp. 158, 160, Figure 10.2, Table 10.1

Self-help groups are useful for reducing stress because they provide the individual with the stress mediator identified as a. Social support b. Cultural support c. Life satisfaction d. Cognitive reframing

a. Self-help groups often provide a high level of social support. Members meet and are encouraged and sustained by others who share the same problem. p. 161

Carolina is surprised when her patient does not show for a regularly scheduled appointment. When contacted, the patient states, "I don't need to come see you anymore. I have found a therapy app on my phone that I love." How should Carolina respond to this news? a. "That sounds exciting, would you be willing to visit and show me the app?" b. "At this time, there is no real evidence that the app can replace our therapy." c. "I am not sure that is a good idea right now, we are so close to progress." d. "Why would you think that is a better option than meeting with me?"

a. "That sounds exciting, would you be willing to visit and show me the app?"

What principle about nurse-patient communication should guide a nurse's fear about "saying the wrong thing" to a patient? a. Patients tend to appreciate a well-meaning person who conveys genuine acceptance, respect, and concern for their situation. b. The patient is more interested in talking to you than listening to what you have to say and so is not likely to be offended. c. Considering the patient's history, there is little chance that the comment will do any actual harm. d. Most people with a mentally illness have by necessity developed a high tolerance of forgiveness.

a. Patients tend to appreciate a well-meaning person who conveys genuine acceptance, respect, and concern for their situation.

The nurse caring for a client with Alzheimer's disease can anticipate that the family will need information about therapy with antihypertensives. benzodiazepines. immunosuppressants. acetylcholinesterase inhibitors.

acetylcholinesterase inhibitors. Memory deficit is thought to be related to a lack of acetylcholine at the synaptic level. Acetylcholinesterase inhibitor drugs prevent the chemical that destroys acetylcholine from acting, thus leaving more available acetylcholine.REF: Page 447

The physician mentions to the nurse that a client who is about to be admitted has "sundowning." The nurse can expect to assess nightly agitation. lethargy. depression. mania.

agitation. Sundowning involves increased disorientation and agitation occurring at night.REF: Page 442

A client diagnosed with Alzheimer's disease looks confused when the phone rings and cannot recall many common household objects by name, such as a pencil or glass. The nurse can document this loss of function as apraxia. agnosia. aphasia. anhedonia.

agnosia. Agnosia is loss of the ability to recognize familiar objects.REF: 438

Rosa, a 78-year-old patient with Alzheimer's disease, picks up her glasses from the bedside table but does not recognize what they are or their purpose. She is experiencing: apraxia. agnosia. aphasia. agraphia.

agnosia. Agnosia is the loss of sensory ability to recognize objects. Apraxia is the loss of purposeful movement in the absence of motor or sensory impairment. Aphasia is the loss of language ability. Agraphia is the loss of the ability to read or write.Cognitive Level: Remember (Knowledge)Nursing Process: AssessmentNCLEX: Psychosocial IntegrityText page: 438

The family of a client diagnosed with Alzheimer's disease mentions to the nurse that seeing his loss of function has been very difficult. A nursing diagnosis that might be considered for such a family would be ineffective denial. anticipatory grieving. disabled family coping. ineffective family therapeutic regimen management.

anticipatory grieving. Anticipatory grieving involves working through potential loss.REF: 442-443

Using Maslow's model of needs, the nurse providing care for an anxious client identifies the priority intervention to be a. assessing the client's success at fulfilling her appropriate developmental level tasks. b. assessing the client for her strengths upon which a nurse-client relationship can be based. c. planning one-on-one time with the client to assist in identifying the fears behind her anxiety. d. evaluating the client's ability to learn and retain essential information regarding her condition.

assessing the client for her strengths upon which a nurse-client relationship can be based

2. Which question should the nurse ask when assessing for what Sullivan's Interpersonal Theory identifies as the most painful human condition? a. "Is self-esteem important to you?" b. "Do you think of yourself as being lonely?" c. "What do you do to manage your anxiety?" d. "Have you ever been diagnosed with depression?"

b

10. A patient is telling a tearful story. The nurse listens empathically and responds therapeutically with: a. "The next time you find yourself in a similar situation, please call me." b. "I am sorry this situation made you feel so badly. Would you like some tea?" c. "Let's devise a plan on how you will react next time in a similar situation." d. "I am sorry that your friend was so thoughtless. You should be treated better."

c

The first stage of the general adaptation syndrome can be characterized as a. Eustress b. Adaptive c. Maladaptive d. Psychological

b. The initial adaptive response of the general adaptation syndrome prepares the individual to fight or flee in the face of acute stress.

Which statement made by the nurse demonstrates the best understanding of nonverbal communication? a. "The patient's verbal and nonverbal communication is often different." b. "When my patient responds to my question, I check for congruence between verbal and nonverbal communication to help validate the response." c. "If a patient is slumped in the chair, I can be sure he's angry or depressed." d. "It's easier to understand verbal communication that nonverbal communication."

b. "When my patient responds to my question, I check for congruence between verbal and nonverbal communication to help validate the response."

You have been working closely with a patient for the past month. Today he tells you he is looking forward to meeting with his new psychiatrist but frowns and avoids eye contact while reporting this to you. Which of the following responses would most likely be therapeutic? a. "A new psychiatrist is a chance to start fresh; I'm sure it will go well for you." b. "You say you look forward to the meeting, but you appear anxious or unhappy." c. "I notice that you frowned and avoided eye contact just now. Don't you feel well?" d. "I get the impression you don't really want to see your psychiatrist—can you tell me why?"

b. "You say you look forward to the meeting, but you appear anxious or unhappy."

Which student behavior is consistent with therapeutic communication? a. Offering your opinion when asked to convey support. b. Summarizing the essence of the patient's comments in your own words. c. Interrupting periods of silence before they become awkward for the patient. d. Telling the patient he did well when you approve of his statements or actions.

b. Summarizing the essence of the patient's comments in your own words.

What is the physiologic basis for the success of guided imagery? beta-endorphin release raises the pain threshold Imagery raises the body level of cortisol and epinephrine The sympathetic nervous system is stimulated to produce a quiet state Brain catecholamines are less available to transmit pain impulses

beta-endorphine release raises the pain threshold Guided imagery stimulates release of β-endorphins, a brain chemical that raises the individual's pain threshold. In so doing, the guided imagery is responsible for making the client more comfortable. None of the other options are accurate explanations of this process

A client with hypertension uses an automatic cycling blood pressure cuff with audible changing tones. The client uses relaxation techniques to lower her blood pressure and is informed of her ongoing success by the tone. This process describes biofeedback guided imagery therapeutic touch assertiveness training

biofeedback Biofeedback is a technique for gaining conscious control over unconscious processes. The scenario describes one method that might accomplish this

Which approach to reducing client stress is most effective in people with low to moderate hypnotic ability? meditation breathing exercises journal keeping biofeedback

biofeedback Biofeedback is usually thought to be most effective in people with low to moderate hypnotic ability. For people with hypnotic ability, meditation, progressive muscle relaxation, and other cognitive-behavioral therapy techniques produce the most rapid reduction in clinical symptoms

4. When considering the suggestions of Hildegard Peplau, which activity should the nurse regularly engage in to ensure that the patient stays the focus of all therapeutic conversations? a. Assessing the patient for unexpressed concerns and fears b. Evaluating the possible need for additional training and education c. Reflecting on personal behaviors and personal needs d. Avoiding power struggles with the manipulative patient

c

When an APSU student nurse has the thought "I can't pass this course" and replaces it with a self statement like "if I choose to study for this test I will increase my chances of success". The student has achieved the goal of: Mindfulness Cognitive reframing Meditation Relaxation Response

cognitive reframing

A patient is extremely depressed after ending a relationship with a partner. The nurse is teaching cognitive reframing techniques to this patient as a means to counteract depression. Which response given by the patient indicates effective teaching by the nurse? a. "'My partner will realize that I was not wrong." b. "I was destined to face this situation in my life." c. "I have many friends who love and care for me." d. "I will never think about my partner again in my life."

c. The nurse should teach cognitive reframing to patients who are depressed and suffer from self-blame. It helps the patients develop positive insight towards life and real-life situations. In this regard, the patient's response, "I have many friends who love and care for me," is appropriate because it is a positive statement. The response, "I will never think about my partner again in my life," is not appropriate. It indicates that the patient is not accepting the reality and avoids thoughts related to the incident. The response, "My destiny is responsible for the breakup," is not appropriate either. It indicates that the patient is compromising with the situation. The response, "My partner will realize that I was not wrong," is not appropriate. The patient is reflecting anger and distress in this response. p. 167

An adult patient admitted with anxiety states, "My counselor keeps talking about my stressors. What exactly are stressors?" How does the nurse best respond to the patient? a. "Stressors are complicated neurostimuli that cause mental illness." b. "Instead of focusing on what stressors are, let's explore your coping skills." c. "Stressors are events that threaten your current functioning and require you to adapt." d. "It's best if you ask questions like that of your health care provider for a complete answer."

c. "Stressors are events that threaten your current functioning and require you to adapt." The statement "Stressors are events that threaten your current functioning and require you to adapt" is the best explanation of stressors. Stressors are not complicated neurostimuli; telling the patient to address these questions to the health care provider fails to educate the patient, which is the nurse's responsibility. Exploring coping skills would be a good intervention at a later time but does not address the patient's question and changes the subject.

James is a 42-year-old patient with schizophrenia. He approaches you as you arrive for day shift and anxiously reports, "Last night, demons came to my room and tried to rape me." Which response would be most therapeutic? a. "There are no such things as demons. What you saw were hallucinations." b. "It is not possible for anyone to enter your room at night. You are safe here." c. "You seem very upset. Please tell me more about what you experienced last night." d. "That must have been very frightening, but we'll check on you at night and you'll be safe."

c. "You seem very upset. Please tell me more about what you experienced last night."

Emily is a 28-year-old nurse who works on a psychiatric unit. She is assigned to work with Jenna, a 27-year-old who was admitted with major depressive disorder. Emily and Jenna realize that they graduated from the same high school and each has a 2-year-old daughter. Emily and Jenna discuss getting together for a play date with their daughters after Jenna is discharge. This situation reflects: a. successful termination b. promoting interdependence c. boundary blurring d. a strong therapeutic relationship

c. boundary blurring

5. Which action reflects therapeutic practices associated with operant conditioning? a. Encouraging a parent to read to their children to foster a love for learning b. Encouraging a patient to make daily journal entries describing their feelings c. Suggesting to a new mother that she spend time cuddling her newborn often during the day d. Acknowledging a patient who is often verbally aggressive for complimenting a picture another patient drew

d

6. A nurse is assessing a patient who graduated at the top of his class but now obsesses about being incompetent in his new job. The nurse recognizes that this patient may benefit from the following type of psychotherapy: a. Interpersonal b. Operant conditioning c. Behavioral d. Cognitive-behavioral

d

9. Linda is terrified of spiders and cannot explain why. Because she lives in a wooded area, she would like to overcome this overwhelming fear. Her nurse practitioner suggests which therapy? a. Behavioral b. Biofeedback c. Aversion d. Systematic desensitization

d

A Hispanic woman has been in an abusive relationship for 3 years. Which comment by this patient is most likely? a. "I need help with preparing an escape plan." b. "I feel so depressed about the failure of my marriage." c. "He is not a good man. His father and brother are also abusive." d. "I have very bad headaches that make it hard for me to care for my children."

d. The patient is experiencing severe stress but expressing it somatically. The overwhelming majority of Asians, Africans, and Central Americans tend to express distress in somatic terms and actually experience it physically. In the correct answer, the patient has expressed her distress about the abuse with complaints of headaches. Although Western European and North American cultures tend to subscribe to a psychophysiologic view of stress and somatic distress, this is not the dominant view in other cultures. The incorrect responses depict emotional recognition of stress associated with the abuse. p. 162

Which nursing statement is an example of reflection? a. "I think this feeling will pass." b. "So you are saying that life has no meaning." c. "I'm not sure I understand what you mean." d. "You look sad."

d. "You look sad."

Therapeutic communication is the foundation of a patient- centered interview. Which of the following techniques is not considered therapeutic? a. Restating b. Encouraging description of perception c. Summarizing d. Asking "why" questions

d. Asking "why" questions

When preparing educational materials for the family of a client diagnosed with progressive dementia, the nurse will include information related to local: (select all that apply): day care centers legal professionals home health services family support groups professional counseling

day care centers home health services family support groups professional counseling Most importantly, families need to know where to get help. Help includes professional counseling and education regarding the process and progression of the disease. Families especially need to know about and be referred to community-based groups that can help shoulder this tremendous burden (e.g., day care centers, senior citizen groups, organizations providing home visits and respite care, and family support groups). While legal professionals may be of interest to the family, client and family education does not include such services.REF: Page 446

The family members of a client with stage 1 Alzheimer's disease have jobs and cannot provide adequate supervision for the client. A reasonable alternative for the nurse to explore with them would be day care. acute care hospitalization. long-term institutionalization. group home residency.

day care. Day care is a good option for clients with early-stage Alzheimer's disease. It provides supervision, a protected environment, and supportive interactions.REF: Page 442

An effective stress-reduction technique a nurse might teach an individual with performance anxiety is assertiveness journal keeping deep breathing restructuring and setting priorities

deep breathing Changing the breathing pattern can be highly effective in aborting or mitigating the high anxiety level associated with performance anxiety. None of the other options are typically associated with anxiety management

Freud believed that individuals cope with anxiety by using ...

defense mechanisms

A family member reports that the client had been oriented and able to carry on a logical conversation last evening but this morning is confused and disoriented. The nurse can suspect that the client is displaying symptoms associated with which cognitive disorders a) Delirium b) Dementia c) Amnesic disorder d) Selective inattention

delirium

A family member reports that the client had been oriented and able to carry on a logical conversation last evening, but this morning she is confused and disoriented. The nurse can suspect that the client is displaying symptoms associated with delirium. dementia. amnesic disorder. selective inattention.

delirium. Delirium is characterized by a disturbance of consciousness, a change in cognition (such as impaired attention span), and a fluctuating level of consciousness that develop over a short period of time.REF: Page 432

creation of stories in place of missing memories to maintain self-esteem

denial confabulation

The patient you are assigned unexpectedly suffers a cardiac arrest. During this emergency situation, your body will produce a large amount of: carbon dioxide growth hormone epinephrine aldosterone

epinephrine

The nurse is working with a client experiencing both post-partum depression and very low self-esteem. The client is distrustful of unit staff and "just wants to go home." Initially, the nurse's priority is to...

establish trust with the client

When a delirious client insists that a vacuum hose is a large, poisonous snake, the nurse recognizes that this client is hallucinating. experiencing an illusion. hypervigilant. demonstrating agnosia.

experiencing an illusion. Illusions are errors in the perception of a sensory stimulus.REF: 433

A client diagnosed with delirium strikes out at a staff member. The nurse can most correctly hypothesize that this behavior is related to which characteristic symptom of delirium a) Anger b) Fear c) Unmet physical needs d) Unmet social interaction

fear

A client with delirium strikes out at a staff member. The nurse can most correctly hypothesize that this behavior is related to anger. fear. an unmet physical need. the need for social interaction.

fear. Clients with delirium often misinterpret reality, perceiving threat where none actually exists. Delirious clients who are fearful may strike out at others, seemingly without provocation.REF: 435

Maslow's theory of humanistic psychology has provided nursing with a framework for...

holistic assessment

Your patient lost his mother at a young age due to a car wreck on her way to the store. He says, "it must have been a long line there because I haven't seen her since." The patient is using what technique to decrease his stress? Guided Imagery Humor Meditation Biofeedback

humor

When considering stress , what is the primary goal of making daily entries into a personal journal? providing a distraction from the daily stress expressing emotions to manage stress identifying stress triggers focusing on one's stress

identifying stress triggers

When a delirious client insists that a vacuum hose is a large, poisonous snake, the nurse recognizes that this client is experiencing what characteristic symptom a) Hallucinations b) Illusion c) Hypervigilant d) Agnosia

illusion

Trudy is a 72-year-old patient hospitalized with pneumonia and experiencing delirium. She points to her IV pole and screams, "Get him out of here! He's going to hurt me!" You recognize that what Trudy is experiencing is a(n): hallucination. delusion. illusion. confabulation.

illusion. ILLUSIONS are errors in perception of sensory stimuli. The stimulus is a real object in the environment; however, it is misinterpreted and often becomes the object of the patient's projected fear. HALLUCINATIONS are false sensory stimuli. For example, individuals experiencing delirium may become terrified when they "see" giant spiders crawling over the bedclothes or "feel" bugs crawling on or under their bodies. A DELUSION is described as thinking or believing something that is not true and is seen more often in schizophrenia. For example, a patient may firmly believe that government agencies can read and are monitoring his or her thoughts or that neighbors can see him or her through walls. CONFABULATION is the creation of stories or answers in place of actual memories to maintain self-esteem.Cognitive Level: Understand (Comprehension)Nursing Process: AssessmentNCLEX: Psychosocial IntegrityText page: 434

real objects that are misinterpreted (ex: shadows look like faces/objects)

illusions

Hugo is 21 and diagnosed with schizophrenia. His history includes significant turmoil as a child and adolescent. Hugo reports his father was abusive and routinely beat him, all of his siblings, and his mother. Hugo's early exposure to stress most likely: made him resilient to stressful situations increased his future vulnerability to psychiatric disorders developed strong survival skills shaped his nurturing nature

increased his future vulnerability to psychiatric disorders

An initial intervention the nurse might suggest to the family members of a client diagnosed with Alzheimer's disease who has begun incontinence would be to label the bathroom door with a picture. provide toileting on an as-needed basis. apply disposable diapers. encourage hourly toileting.

label the bathroom door with a picture. Labeling doors and various items with pictures can be helpful for a client who has forgotten where things are and what certain items are.REF: Page 447 (Table 23-7)

Distress can be defines as Hopefulness negative draining energy energy that motivates positive beneficial energy

negative draining energy

A cumulative final exam can be used as a perfect example of what type of stressor? Physiological Negative psychological Positive psychological B and C

negative psychological positive psychological

Which of these situations are NOT recognized as being capable of producing stress and triggering stress response? fatigue emotional arousal prayer humiliation extreme happiness

prayer

repetition of phrases or behavior

preservation

The term "perceptual disturbance" refers to difficulty processing information about one's internal and external environment. changing one's way of thinking to accommodate new information. performing purposeful motor movements. formulating words appropriately.

processing information about one's internal and external environment. Perceptual distortion refers to impaired ability to process intellectual, sensory, and emotional data in a logical, meaningful way.REF: 433

Jackson has suffered from migraine headaches all of his life. Fatima, his nurse practitioner, suspects muscle tension as a trigger for his headaches. Fatima teaches him a technique that promotes relaxation by using: biofeedback guided imagery deep breathing progressive muscle relaxation

progressive muscle relaxation

Amy, a 30 year old single mother lives in a neighborhood that has frequent break-ins. Her children are 2 and 5 years old and ask her if they are safe where they live. This is an example of what kind of stressor? Physiological Psychological Psychosocial Operational

psychological

Meditation is successful in promoting stress reduction because it brings about which outcome? Prevents endorphin release. Changes the client's energy field. Quiets the sympathetic nervous system. Activates the parasympathetic nervous system.

quiets the sympathetic nervous system Sympathetic nervous system stimulation prepares the body for fight or flight in response to stress. Meditation reduces this state of alert by eliciting a relaxation response by creating a hypometabolic state of quieting the sympathetic nervous system. None of the other options accurately describe the process

First responders and emergency department healthcare providers often use dark humor in an effort to: reduce stress and anxiety relive the experience rectify moral distress alert others to the stress

reduce stress and anxiety

A nursing diagnosis appropriate for a client with Alzheimer's disease, regardless of the stage, would be risk for injury. acute confusion. imbalanced nutrition. impaired environmental interpretation syndrome.

risk for injury. Memory loss, agnosia, poor judgment, and the other symptoms of Alzheimer's disease contribute to placing the client at risk for injuries such as burns and falling down stairs.REF: 435

Ophelia, a 69 year old retired nurse, attends a reunion of her former coworkers, ophelia is concerned because she usually knows everyone and she cannot recognize faces today. A registered nurse colleague recognizes Ophelia's distress and "introduces" Ophelia to those attending. The NP recognizes that Ophelia seems to have a deficit in a) Lower level cognitive domain b) Delirium threshold c) Executive function d) Social cognition

social cognition

Self-help groups are useful for reducing stress because they provide th individual with the stress mediator that take what form? Social support Cultural support Life satisfaction Cognitive reframing

social support Self-help groups often provide a high level of social support. Members meet and are encouraged and sustained by others who share the same problem. None of the other options are expected to be provided by the self-help group format

A client diagnosed with Alzheimer's disease has become more forgetful and has difficulty performing familiar tasks like bathing and dressing. The nurse would assess the client as being in the stage of Alzheimer's disease labeled stage 1, mild. stage 2, moderate. stage 3, moderate-severe. stage 4, end.

stage 3, moderate-severe. Moderate-severe Alzheimer's disease requires a high level of supervision because of the severe memory loss the client is experiencing. Wandering and inability to meet self-care needs become problematic.REF: Page 440 (Table 23-3)

What factor exerts the greatest influence on the degree to which various life events upset a specific individual? -The individual's perception of the event -The individual's degree of spirituality -The effect of the individual's health-sustaining behaviors -The amount of social support available to the individual

the individual's perception of the event Researchers have looked at the degree to which various life events upset specific individuals. They have found that the perception of a recent life event determines the person's emotional and psychological reactions to it. While the other options may be factors none contribute to the degree of stress than one's perception of the stressor