465 practice

A child who has witnessed the murder of his classmate while at school would experience which kind of loss? A) Physiologic loss B) Loss of self-esteem C) Loss related to self-actualization D) Safety loss

A child who has witnessed the murder of his classmate while at school would experience which kind of loss? A) Physiologic loss B) Loss of self-esteem C) Loss related to self-actualization D) Safety loss

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

ANS : A,C ,D

A client being served in a busy inpatient psychiatric unit becomes very noisy and combative. The other clients are complaining about the noise and are afraid that they will be hurt by the client. The nurse determines that the best course of action for all involved is to seclude the client until the client is able to regain control of his behavior. On which ethical principle did the nurse base this decision? A) Utilitarianism B) Deontology C) Nonmaleficence D) Veracity

ANS A

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

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

Two nurses are discussing the rights of hospitalized psychiatric clients. Which of the following statements is an error? A) Confidentiality allows for the disclosure of information under specific circumstances. B) If a committed client is also found to be incompetent, he loses his rights under the Patient's Bill of Rights. C) Privileged communication does not apply to medical records, and they can be used in court. D) Clients can never be held against their will.

ANS B

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

ANS B

An abnormality of which of the following structures of the cerebrum would be associated with schizophrenia? A) Parietal lobes B) Frontal lobe C) Occipital lobe D) Temporal lobes

ANS B Feedback: Abnormalities in the frontal lobes are associated with schizophrenia, attention deficit hyperactivity disorder (ADHD), and dementia. The parietal lobes interpret sensations of taste and touch and assist in spatial orientation. The temporal lobes are centers for the senses of smell and hearing and for memory and emotional expression. The occipital lobe assists in coordinating language generation and visual interpretation, such as depth perception.

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

ANS B Feedback: Keeping secrets with a client is not permissible, especially when the client's safety is concerned. The other choices would be inappropriate responses in this situation.

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

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

Which of the following factors would be the most influential in determining a client's response to a particular stressor? A) The client's experience with stress B) The client's perception of the stressor C) Duration of the stressor D) Severity of the stressor

ANS B Feedback: The client will respond to the stressor based on his or her appraisal (perception) of the stressor. Resilience is related to positive outlook. The client's experience with stress, the duration of the stressor, and the severity of the stressor would not be the most influential in determining a client's response to a stressor

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

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

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

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

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

ANS B Feedback: If a client tells a professional that the he or she has homicidal thoughts, the professional is released from privileged communication. The nurse is then required to notify intended victims and police of such a threat. The nurse must report the homicidal threat to the nursing supervisor and attending physician so that both the police and the intended victim can be notified.

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

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

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

ANS B Feedback: When the nurse states, ìYou're having very frightening thoughts,î the nurse is verbalizing the implied or voicing what the client has hinted or suggested. The other responses would not be the best initial response in this situation

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

ANS C Feedback: Touching a client can be comforting and supportive when it is welcome and permitted. The nurse should not express sympathy to patients, nor should attempt to be ìfriendsî with patients. Physical assessment is not indicated at this time.

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

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

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

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

A client is actively involved in community service activities. The benefit of involvement in meaningful daily activities will most directly contribute to which of the following attributes? A) Self-efficacy B) Resilience C) Resourcefulness D) Hardiness

ANS D Feedback: Hardiness is the ability to resist illness when under stress. Hardiness has three components: commitmentóactive involvement in life activities; controlóability to make appropriate decisions in life activities; and challengeóability to perceive change as beneficial rather than just stressful. Self-efficacy is a belief that personal abilities and efforts affect the events in our lives. Resilience is defined as having healthy responses to stressful circumstances or risky situations. Resourcefulness involves using problemsolving abilities and believing that one can cope with adverse or novel situations

Spirituality is especially important in helping people cope primarily for which of the following reasons? A) Spirituality helps people set personal goals. B) Spirituality gives people meaningful daily activities in which to participate. C) Spirituality provides a reliable support network. D) Spirituality guides beliefs about the meaning of life events.

ANS D Feedback: Spirituality involves the essence of a person's being and his or her beliefs about the meaning of life and the purpose for living. Spirituality is a genuine help to many adults with mental illness, serving as a primary coping device and a source of meaning and coherence in their lives. It may also help to provide a social network, but it serves primarily as a belief system. Personal goal setting is a demonstration of self-efficacy. Hardiness is enhanced through commitment to meaningful daily activities

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

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

Which of the following dilemmas involve the ethical principle of fidelity? Select all that apply. A) When the nurse is unable to agree with the policies or common practices of an agency B) When the nurse is faced with a decision to violate a policy that is harmful to the client C) When the nurse is certain that clients of different racial and ethnic backgrounds are being treated the same as other clients D) When the nurse understands that a combative client must be secluded against their will to prevent harm to others E) When the client refuses to take medication and the nurse respects the client's right to refuse medication

ANS: A + B

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

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

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

ANS: B

When the client asks the nurse how long it will take before the SSRI antidepressant medication will be effective, which of the following replies is most accurate and therapeutic? A) ìThis is a good medication! It will be effective within 20 minutes of the first dose.î B) ìYou will have gradual improvement in symptoms over the next few weeks, but the changes may be so subtle that you may not notice them for a while. It is important for you to keep taking the medication.î C) ìIt will probably take months for the medication to work. In the meantime, you should work on improving your attitude.î D) ìIf you believe it will work, then it will. You have to have faith!î

ANS: B SSRIs may be effective in 2 to 3 weeks. Researchers believe that the actions of these drugs are an ìinitiating eventî and that eventual therapeutic effectiveness results when neurons respond more slowly, making serotonin available at the synapses. The medication will not be effective within 20 minutes of the first dose, and it will not likely take months for the medication. Attitude and faith will improve with the medication's effectiveness.

The nurse asks a patient to list the days of the week in reverse order. The nurse is assessing which of the following? A) Concentration B) Memory C) Orientation D) Abstract thinking

Ans: A Feedback: The nurse assesses the client's ability to concentrate by asking the client to perform certain tasks such as repeating the days of the week backward. The nurse directly assesses memory, both recent and remote, by asking questions with verifiable answers. Orientation refers to the client's recognition of person, place, and time. Abs

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

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

The school nurse is teaching a health class about recognizing the signs of abusive relationships. The nurse describes the cycle of violence. The nurse would document effective teaching if the students identify the cycle of violence to be which of the following patterns? Select the order in which the events occur. A. Tension building B. Honeymoon period C. Violent behavior D. Period of remorse

Ans: A, C, D, B Feedback: The tension-building phase begins; there may be arguments, stony silence, or complaints from the husband. The tension ends in another violent episode after which the abuser once again feels regret and remorse and promises to change. This cycle continually repeats itself. Each time, the victim keeps hoping the violence will stop.

The patient states that he is 14 trillion years old and created the world. The nurse documents this statement as an example of which type of thinking displayed by the patient? A) Delusional thinking B) Ideas of reference C) Word salad D) Hallucination

Ans: A Feedback: A delusion is a fixed false belief not based in reality. Ideas of reference are client's inaccurate interpretation that general events are personally directed to him or her, such as hearing a speech on the news and believing the message had personal meaning. Word salad is flow of unconnected words that convey no meaning to the listener. Hallucinations are false sensory perceptions or perceptual experiences that do not really exist.

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

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

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

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

A client from which of the following cultural groups is likely to prefer closeness in personal space? A) Arab Americans B) Chinese C) Cubans D) African Americans

Ans: A Feedback: Arab Americans prefer closeness in personal space. Chinese keep respectful distance. Cubans have greatly varying preferences for personal space. African Americans respect privacy and use a respectful approach.

Which one of the following statements about the roles that biologic makeup plays in a client's emotional responses is most accurate? A) Biologic differences can affect a client's response to treatment with psychotropic drugs. B) Biologic differences do not affect a client's response to treatment with psychotropic drugs. C) Heredity and biologic factors are under voluntary control. D) Persons cannot change their health status and improve the ability to cope.

Ans: A Feedback: Biologic differences can affect a client's response to treatment with psychotropic drugs. Heredity and biologic factors are not under voluntary control. Persons can change their health status and improve their ability to cope.

An adolescent on the unit is argumentative with staff and peers. The nurse tells the adolescent, ìArguing is not allowed. One more word and you will have to stay in your room the rest of the day.î The nurse's directive is A) inappropriate; room restriction is not treatment in the least restrictive environment. B) inappropriate; the adolescent should be offered a sedative before room restriction. C) appropriate; room restriction is an effective behavior modification technique. D) appropriate; the adolescent should not have conflicts with others

Ans: A Feedback: Clients have the right to treatment in the least restrictive environment appropriate to meet their needs. It means that a client does not have to be hospitalized if he or she can be treated in an outpatient setting or in a group home. It also means that the client must be free of restraint or seclusion unless it is necessary. Verbal and behavioral techniques should be instituted before physical measures such as sedation, restraint, or seclusion.

Which of the following is true about the use of touch with a client with dissociative identity disorder? A) It is best not to touch the client without his or her permission. B) Make sure the client knows the touch is friendly and supportive. C) Touch the client only if you are in his or her direct line of vision. D) Touching will convey a sense of security to the client.

Ans: A Feedback: Clients interpret touch differently, so it is important to assess each client's comfort with being touched; these clients often have a history of abuse, so permission should be given before touch is used.

Which of the following cultural phenomena that should be assessed by the nurse includes preference such as touch and eye contact? A) Communication B) Social organization C) Environmental control D) Biologic variations

Ans: A Feedback: Communication involves verbal and nonverbal communication. Social organization refers to family structure and organization, religious values and beliefs, ethnicity, and culture. Environmental control refers to a client's ability to control the surroundings or direct factors in the environment

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

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

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

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

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

Ans: A Feedback: Establishing a therapeutic relationship is one of the most important responsibilities of the nurse when working with clients

Which of the following medications rarely causes extrapyramidal side effects (EPS)? A) Ziprasidone (Geodon) B) Chlorpromazine (Thorazine) C) Haloperidol (Haldol) D) Fluphenazine (Prolixin)

Ans: A Feedback: First-generation antipsychotic drugs cause a greater incidence of EPS than do atypical antipsychotic drugs, with ziprasidone (Geodon) rarely causing EPS. Thorazine, Haldol, and Prolixin are all first-generation antipsychotic drugs

Genetics have been shown to play which of the following roles in a person's mental and emotional health? A) Several mental disorders appear to run in families. B) Specific genes have been linked to certain mental disorders. C) Biologic factors can be modified to change the influence on emotional health. D) Psychiatric treatment is effective regardless of an individual's biologic influences.

Ans: A Feedback: Heredity and biologic factors are not under voluntary control. We cannot change these factors. Research has identified genetic links to several disorders. Although specific genetic links have not been identified for several mental disorders (e.g., bipolar disorder, major depression, and alcoholism), research has shown that these disorders tend to appear more frequently in families. Genetic makeup tremendously influences a person's response to illness and perhaps even to treatment.

The client spoke of a current event in the national news and described it as it relates to the client. Then the client spoke of a historical event and described it as it relates to the client. Which of the following questions might the nurse ask to determine if the client is experiencing ideas of reference? A) ìWhere were you when this happened?î B) ìWhy do you think that?î C) ìAre you sure?î D) ìThat is unbelievable!î

Ans: A Feedback: Ideas of reference are the client's inaccurate interpretation that general evens are personally directed to him or her, such as hearing a speech on the news and believing the message had personal meaning. ìWhere were you when this happened,î would relate to the place and might give the nurse more information to validate the client's previous comments. ìWhy do you think that,î may be interpreted as the nurse challenging the client. ìAre you sure,î is a closed-ended question and does not encourage the client to elaborate. ìThat is unbelievable,î is a statement rather than a question and could be interpreted as the nurse's opinion of the information provided by the client.

The nurse is preparing to administer PRN medication to a client of a Japanese descent who is anxious. The prescription reads, ìAlprazolam (Xanax) 0.25 to 1.0 mg PO PRN.î The best dose for the nurse to give initially is A) 0.25 mg. B) 0.5 mg. C) 0.75 mg. D) 1.0 mg.

Ans: A Feedback: In general, nonwhites treated with Western dosing protocols have higher serum levels per dose and suffer more side effects. Persons of Asian descent often metabolize drugs more slowly, requiring lower doses to produce therapeutic effects.

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

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

Which of the following clients would most likely be mandated outpatient treatment? A) A client who is addicted to alcohol who has two DUI offenses B) A client with schizophrenia who lives in a single family home with siblings C) A client with bipolar disorder who has quit three jobs in the last 6 months D) A homeless client who has been arrested for petty theft of groceries from a convenience store.

Ans: A Feedback: Mandatory outpatient treatment is sometimes also called conditional release or outpatient commitment. Court-ordered outpatient treatment is most common among persons with severe and persistent metal illness who have had frequent and multiple contacts with mental health, social welfare, and criminal justice agencies. This supports the notion that clients are given several opportunities to voluntarily comply with outpatient treatment recommendations and that court-ordered treatment is considered when those attempts have been repeatedly unsuccessful.

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

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

Which of the following is a neuromodulator? A) Neuropeptides B) Glutamate C) Dopamine D) GABA

Ans: A Feedback: Neuropeptides are neuromodulators. Glutamate and dopamine are excitatory neurotransmitters. GABA is an inhibitory neurotran

A patient is being seen in the crisis unit reporting that poison letters are coming in the mail. The patient has no history of psychiatric illness. Which of the following medications would the patient most likely be started on? A) Aripiprazole (Abilify) B) Risperidone (Risperdal Consta) C) Fluphenazine (Prolixin) D) Fluoxetine (Prozac)

Ans: A Feedback: New-generation antipsychotics are preferred over conventional antipsychotics because they control symptoms without some of the side effects. Injectable antipsychotics, such as Risperdal Consta, are indicated after the client's condition is stabilized with oral doses of these medications. Prozac is an antidepressant and is not indicated to relieve of psychotic symptoms

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

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

Friends of a teenage male recently killed in a car accident are discussing their sense of loss. Which of the following comments best indicates that the friends are trying to make sense of the loss cognitively? A) ìWhy did he have to die so young?î B) ìHe shouldn't have been driving so recklessly.î C) ìIf we had only stayed longer, he would not have been on that road.î D) ìIt took the ambulance too long to get there

Ans: A Feedback: One of the cognitive responses to grief involves the grieving person making sense of the loss. He or she undergoes self-examination and questions accepted ways of thinking. The loss challenges old assumptions about life. Anger, sadness, and anxiety are the predominant emotional responses to loss. The grieving person may direct anger and resentment toward the dead person and his or her health practices, family members, or health-care providers or institutions.

When teaching a client about restrictions for tranylcypromine (Parnate), the nurse will tell the client to avoid which of the following foods? A) Broad beans B) Citrus fruit C) Egg products D) Fried foods

Ans: A Feedback: Parnate is a monoamine oxidase inhibitor; clients must avoid tyramine, and broad beans contain tyramine. Answers citrus fruit, egg products, and fried foods are not tyraminecontaining foods.

A client's prognosis is said to be good due to a high degree of self-efficacy. Which of the following is evidence of a high degree of self-efficacy? A) The client is self-motivated and asks for help when needed. B) The client is able to resist illness when under stress. C) The client responds well in stressful situations. D) The client uses good problem-solving abilities

Ans: A Feedback: People with high self-efficacy set personal goals, are self-motivated, cope effectively with stress, and request support from others when needed. Hardiness is the ability to resist illness when under stress. Resilience is defined as having healthy responses to stressful circumstances or risky situations. Resourcefulness involves using problemsolving abilities and believing that one can cope with adverse or novel situations.

Which one of the following statements is most accurate regarding the age at onset of a mental illness such as schizophrenia? A) Persons who are diagnosed at a younger age will more likely have a poorer outcome. B) Persons who are diagnosed at a younger age will more likely have a better outcome. C) Age at diagnosis is not related to outcomes. D) Younger clients have more experiences that will help them.

Ans: A Feedback: Persons who are diagnosed with schizophrenia at a younger age at onset have poorer outcomes, such as more negative signs and less effective coping skills, than do people with a later age at onset. A possible reason for this difference is that younger clients have not had experiences of successful independent living or the opportunity to work and be self-sufficient and have a less well-developed sense of personal identity than older clients

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

Ans: A Feedback: Restating is repeating the main idea expressed. Restatement lets the client know that he or she communicated the idea effectively. This encourages the client to continue. Focusing or concentrating on a single point encourages the client to concentrate his or her energies on a specific point, which may prevent a multitude of factors or problems from overwhelming the client. General leads give encouragement to continue. They indicate that the nurse is listening and following what the client is saying without taking away the initiative for the interaction. Placing events in sequence clarifies the relationship of events in time. This helps both the nurse and the client to see them in perspective.

Which of the following situations would most likely provide social support to a client? A) A friend who will share his or her perspective on an issue B) The transportation service that provides access to daily rehabilitation services C) Fellow teammates participating in a community softball league D) The teacher assisting a client to obtain a GED

Ans: A Feedback: Social support is emotional sustenance that comes from friends, family members, and even health-care providers who help a person when a problem arises. It is different from social contact, which does not always provide emotional support. An example of social contact is the friendly talk that goes on at parties.

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

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

A holistic plan of recovery would be especially important to a client from which of the following cultural groups? A) American Indian B) African American C) Mexican American D) Arab American

Ans: A Feedback: The American Indians' concept of health is holistic and wellness oriented. African Americans and Mexican Americans value feelings of well-being, ability to fulfill role expectations, and being free of pain or excess stress. Arab Americans view health as a gift of God manifested by eating well, meeting social obligations, being in a good mood, and having no stressors or pain.

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

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

The police find a woman wandering around a parking lot, singing very loudly. They bring her to the hospital; she has no knowledge of what she has been doing for the past 12 hours and is dressed in unfamiliar clothing. This is an example of A) dissociation. B) manipulation. C) psychosis. D) regression

Ans: A Feedback: The client experienced a temporary alteration in conscious awareness. This situation is not an example of manipulation. The woman is not experiencing psychosis. Regression occurs when there is a retreat to an earlier stage of development and comfort

The nurse is assessing a patient suffering a head injury as a result of an altercation with two other individuals. The patient has difficulty accurately reporting the events of the altercation and appears very emotional during the assessment. The nurse suspects which part of the brain received the greatest amount of injury? A) Cerebrum B) Cerebellum C) Medulla D) Amygdala

Ans: A Feedback: The frontal lobes of the cerebrum control the organization of thought, body movement, memories, emotions, and moral behavior. The cerebellum is located below the cerebrum and is the center for coordination of movements and postural adjustments. The medulla, located at the top of the spinal cord, contains vital centers for respiration and cardiovascular functions. The hippocampus and amygdala are involved in emotional arousal and memory

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

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

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

Ans: A Feedback: The nurse who appreciates the client as a unique worthwhile human being can respect the client regardless of his or her behavior, background, or lifestyle. The nurse maintains attention on the client and avoids communicating negative opinions or value judgments about the client's behavior. In using positive regard, the nurse avoids value judgments and shifting of the focus away from the patient

The nurse on an addictive disorders unit receives a phone call inquiring about the status of a client. The caller is not on the client's allowed contact list. Which of the following is the appropriate response by the nurse to the caller? A) ìI cannot confirm or deny the existence of any client here.î B) ìYou will need to be placed on the client's contact list before I can discuss any information with you.î C) ìThe person you are asking for is not a client here.î D) ìHold 1 minute while I get the client for you.î

Ans: A Feedback: The protection and privacy of personal health information is regulated by the federal government through the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Protected health information is any individually identifiable health information in oral, written, or electronic form. Mental health and substance abuse records have additional special protection under the privacy rules. Requesting placement on the contact list or getting the client verifies the client's presence to the caller. Denying the client's presence affirms the client's existence whether present not, which violates client privacy and confidentiality

Which of the following theories about anxiety is based upon intrapsychic theories? A) A person's innate anxiety is the stimulus for behavior. B) Anxiety is generated from problems in interpersonal relationships. C) A nurse can help the client to achieve health by attending to interpersonal and physiologic needs. D) Anxiety is learned through experiences

Ans: A Feedback: Theories of anxiety can be classified as intrapsychic/psychoanalytic theories, interpersonal theories, and behavioral theories. Freud's intrapsychic theory views a person's innate anxiety as the stimulus for behavior. Interpersonal theories include Sullivan's theory that anxiety is generated from problems in interpersonal relationships and Peplau's belief that humans exist in interpersonal and physiologic real

Three years after the death of her father in an ICU, the infection prevention nurse was visiting an ICU in a different hospital to complete a chart review. At one point, the nurse looked at a bed where the patient who had the same diagnosis as her father had and saw her father's facial features on the patient and had a sense of panic. In a few moments, the nurse realized that the patient in the bed was not her father. Which of these manifestations of PTSD was this nurse experiencing? A) A flashback B) Emotional numbing C) Hyperarousal D) A dream

Ans: A Feedback: This nurse was experiencing a flashback where similar circumstances triggered a sensation that the stressful experience were happening again.

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

Ans: A Feedback: This statement conveys the nurse's understanding of the client's feelings. Empathy is the ability to place oneself into the experience of another for a moment in time. Nurses develop empathy by gathering as much information about an issue as possible directly from the client to avoid interjecting their personal experiences and interpretations of the situation. The other choices do not convey empathy.

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

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

Which of the following are eventual outcomes of the emotional dimension of grieving? Select all that apply. A) The survivor begins to reestablish a sense of personal identity, direction, and purpose for living. B) The survivor begins to gain independence and confidence. C) The survivor develops new ways of managing life and new relationships. D) The survivor's life returns to the same state as it was before the loss. E) The survivor forgets about the loss

Ans: A, B, C Feedback: Eventually, the bereaved person begins to reestablish a sense of personal identity, direction, and purpose for living. He or she gains independence and confidence. New ways of managing life emerge and new relationships form. The person's life is reorganized and seems ìnormalî again, although different than that before the loss. The person still misses the deceased, but thinking of him or her no longer evokes painful feelings.

Which of the following interventions are most effective in managing the environment to reduce or eliminate aggressive behavior? Select all that apply. A) Planning group activities such as playing games B) Scheduling one-to-one interactions with the client C) Providing structure and consistency in the unit D) Avoiding discussions among clients on the unit E) Discouraging clients from negotiating solutions

Ans: A, B, C Feedback: Group and planned activities such as playing card games, watching and discussing movies, or participating in informal discussions give the clients the opportunity to talk about events or issues when they are calm. Scheduling one-to-one interactions with clients indicates the nurse's genuine interest in the client and a willingness to listen to the client's concerns, thoughts, and feelings. Knowing what to expect enhances the client's feelings of security. Avoiding discussions does not give clients the opportunity to talk about events or issues when they are calm. If clients have a conflict or dispute with one another, the nurse can offer the opportunity for problem solving or conflict resolution. Expressing angry feelings appropriately, using assertive communication statements, and negotiating a solution are important skills clients can practice. These skills will be useful for the client when he or she returns to the community

A client is seeking counseling due to difficulty coping with being a victim of a violent attack 16 months ago. The initial medical diagnosis is to rule out posttraumatic stress disorder (PTSD). Which would the nurse assess for when determining the major elements of PTSD? Select all that apply. A) Reexperiencing the trauma through dreams or recurrent and intrusive thoughts B) Showing emotional numbing such as feeling detached from others C) Being on guard, irritable, or experiencing hyperarousal D) Feeling mildly anxious E) Occurs 2 weeks after the trauma

Ans: A, B, C Feedback: The three major elements of PTSD are reexperiencing the trauma through dreams or recurrent and intrusive thoughts, showing emotional numbing such as feeling detached from others, and being on guard, irritable, or experiencing hyperarousal. Feeling mildly anxious is not a major element of PTSD as the person is likely to feel very anxious. Occurring 2 weeks after the trauma would likely be acute stress disorder as PTSD symptoms occur 3 months or more after the traum

Which of the following are the types of roles that are usually included when assessing roles and relationships? Select all that apply. A) Family B) Hobbies C) Occupation D) Activities E) Race F) Ethnicity

Ans: A, B, C, D Feedback: The number and type of roles may vary, but they usually include family, occupation, and hobbies or activities.

Which of the following are common behavioral and emotional responses to abuse? Select all that apply. A) One third of abusive men are likely to have come from violent homes. B) Women who grew up in violent homes are 50% more likely to expect or accept violence in their own relationships. C) Dependency on the abuser is a common trait found in victims of domestic violence. D) The victim caused the abuse. E) It is critical for the nurse to demonstrate acceptance after hearing about the abuse so that the victim may begin to gain self-acceptance.

Ans: A, B, C, E Feedback: One third of abusive men are likely to have come from violent homes. Women who grew up in violent homes are 50% more likely to expect or accept violence in their own relationships. Dependency on the abuser is a common trait found in victims of domestic violence. The victim may believe that he or she caused the abuse, but this is not accurate. It is critical for the nurse to demonstrate acceptance after hearing about the abuse so that the victim may begin to gain self-acceptance

Which of the following are cognitiveñbehavioral therapy techniques that may be used effectively with anxious clients? Select all that apply. A) Positive reframing B) Decatastrophizing C) Assertiveness training D) Humor E) Unlearning

Ans: A, B, C, E Feedback: Positive reframing means turning negative messages into positive messages. Decatastrophizing involves the therapist's use of questions to more realistically appraise the situation. Assertiveness training helps the person take more control over life situations. Positive reframing, decatastrophizing, and assertiveness training are cognitiveñbehavioral therapy techniques. Humor is not a cognitiveñbehavioral therapy technique. Unlearning is the theory underlying behavioral therapy

Anger management is likely to be included in the care of clients with which of the following psychiatric diagnoses? Select all that apply. A) Alzheimer's dementia B) Schizophrenia C) Anorexia nervosa D) Acute alcohol intoxication E) Generalized anxiety disorder

Ans: A, B, D Feedback: Although most clients with psychiatric disorders are not aggressive, clients with a variety of psychiatric diagnoses can exhibit angry, hostile, and aggressive behavior. Clients with paranoid delusions may believe others are out to get them; believing they are protecting themselves, they retaliate with hostility or aggression. Some clients have auditory hallucinations that command them to hurt others. Aggressive behavior also is seen in clients with dementia, delirium, head injuries, intoxication with alcohol or other drugs, and antisocial and borderline personality disorde

Which of the following disorders are extrapyramidal symptoms that may be caused by antipsychotic drugs? Select all that apply. A) Akathisia B) Pseudoparkinsonism C) Neuroleptic malignant syndrome D) Dystonia E) Anticholinergic effects F) Breast tenderness in men and women

Ans: A, B, D Feedback: Extrapyramidal symptoms include dystonia, pseudoparkinsonism, and akathisia. Neuroleptic malignant syndrome is also a side effect of antipsychotic drugs but is an idiosyncratic reaction to an antipsychotic drug, not an extrapyramidal symptom. Breast tenderness in men and women is also a potential side effect of antipsychotic drugs that cause elevated prolactin levels, but it is not an extrapyramidal symptom.

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

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

Under which conditions would it be in the client's best interest for the court to appoint a conservator, or legal guardian? Select all that apply. A) Gravely disabled B) Mentally incompetent C) Noncompliant D) Unable to provide basic needs when resources exist E) Act only on his or her own interests

Ans: A, B, D Feedback: The appointment of a conservator or legal guardian is a separate process from civil commitment. People who are gravely disabled; are found to be incompetent; cannot provide food, clothing, and shelter for themselves even when resources exist; and cannot act in their own best interests may require appointment of a conservator. In these cases, the court appoints a person to act as a legal guardian who assumes many responsibilities for the person.

A man is discovered wandering the street, looking confused and stepping out into traffic. When emergency responders approach the man, he cannot recall his name or where he lives. The responders transport the man to the mental health crisis unit for further evaluation. Which of the following are the man most likely suffering from? Select all that apply. A) Depersonalization disorder B) Dissociative identity disorder C) Repressed memories D) Dissociative amnesia E) False memory syndrome

Ans: A, B, D Feedback: With dissociative amnesia, the client cannot remember important personal information. With dissociative personality disorder, the client displays two or more distinct identities or personality states that recurrently take control of his or her behavior. With depersonalization disorder, the client has persistent or recurring feeling of being detached from his or her mental processes or body (depersonalization) or sensation of being in a dream-like state where the environment seems foggy or unreal (derealization). The client is not psychotic or out of touch with reality.

Which of the following statements about spirituality are true? Select all that apply. A) Many clients with mental disorders have disturbing religious delusions. B) Religious activities have been shown to be linked with better health and a sense of well-being. C) Spirituality only involves religion. D) Hope and faith are two critical factors in psychiatric and physical rehabilitation. E) Spirituality may include a relationship with the environment.

Ans: A, B, D, E Feedback: Many clients with mental disorders have disturbing religious delusions. Religious activities have been shown to be linked with better health and a sense of well-being. Spirituality involves the essence of a person's being and his or her beliefs about the meaning of life and the purpose for living. It may include belief in God or a higher power, the practice of religion, cultural beliefs and practices, and a relationship with the environment. Hope and faith are two critical factors in psychiatric and physical rehabilitation.

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

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

Which techniques would be most effective for a client who has situational phobias? Select all that apply. A) Flooding B) Reminding the person to calm down C) Systematic desensitization D) Assertiveness training E) Decatastrophizing

Ans: A, C Feedback: Systematic desensitization is when the therapist progressively exposes the client to a threatening object in a safe setting until the client's anxiety decreases. Flooding is a form of rapid desensitization in which the behavior therapist confronts the client with the phobic object until it no longer produces anxiety. Systematic desensitization and flooding are behavioral therapies used in the treatment of phobias. Assertiveness training would help the person to take more control over life situations. Decatastrophizing helps the client to realistically appraise the situation. These are both used for general anxiety. When a person is exposed to a phobic object, the person is not likely in control. Reminding a person to calm down is not at all an effective way to manage anxiety.

The nurse plans to assess a patient's self-concept in the admission assessment knowing that self-concept influences which of the following? Select all that apply. A) Body image B) Cognitive processing C) Frequently experienced emotions D) Coping strategies E) Responsiveness to medications

Ans: A, C, D Feedback: Self-concept is the way one views oneself in terms of personal worth and dignity. The client's description of self in terms of physical characteristics gives the nurse information about the client's body image. Also included in an assessment of selfconcept are the emotions that the client frequently experiences and whether or not the client is comfortable with those emotions. The nurse also must assess the client's coping strategies. Cognitive processing and response to medications are biologically based.

Which of the following are events that a person may experience, witness, or be confronted by that may trigger posttraumatic stress disorder (PTSD)? Select all that apply. A) Being a survivor of a tsunami that resulted in thousands of deaths B) Being stranded at the office during a typical winter storm that was anticipated C) Being a marine in a combat situation where the entire platoon was wiped out except for one person D) Being hidden in a closet and hearing the entire family murdered by someone who broke into the home E) Watching televised segments of the moment when the plane hit the second tower on 9/11

Ans: A, C, D, E Feedback: Examples of events that may cause PTSD include someone experiencing, witnessing, or being confronted by a traumatic event such as a natural disaster, combat, or an assault. The person with PTSD was exposed to an event that posed actual or threatened death or serious injury and responded with intense fear, helplessness, or terror. Being a survivor of a tsunami that resulted in thousands of deaths, being a marine in a combat situation where the entire platoon was wiped out except for one person, and being hidden in a closet and hearing the entire family murdered by someone who broke into the house would be situations where the person was exposed to an event that posed actual or threatened death or serious injury and responded with intense fear, helplessness, or terror.

Which of the following personal characteristics influence a client's response to stressors? Select all that apply. A) Self-efficacy B) Sense of belonging C) Spirituality D) Hardiness E) Resilience F) Resourcefulness

Ans: A, C, D, E, F Feedback: Personal characteristics that influence a client's response to stressors include selfefficacy, spirituality, hardiness, resilience, and resourcefulness. Sense of belonging is an interpersonal factor that can influence a client's response to stressors

The nurse is caring for a hospice client whose death is imminent. In preparing the family for the death of their loved one, then nurse prepares to assist the family in which of the following, regardless of the family's cultural preferences? Select all that apply. A) Dealing with the shock of losing a loved one B) Burial plans after death had occurred C) Efforts to stay connected to the client after death D) Use of support from family and friends E) Anger at the loss of a loved one

Ans: A, C, E Feedback: Universal reactions include the initial response of shock and social disorientation, attempts to continue a relationship with the deceased, anger with those perceived as responsible for the death, and a time for mourning. Not all cultures bury their deceased. Some cultures mourn privately, not turning to the support of others.

Which of the following would be circumstances when a client could be subjected to involuntary hospitalization? Select all that apply. A) When a client states that he or she intends to commit suicide and is making plans to do so. B) When a client does not bathe regularly or change clothes often. C) When a client states that he or she intends to harm others by a deliberate act. D) When a client who has diabetes refuses to follow the prescribed diet. E) When a client is unable to control his or her rage and is assaulting everyone around him or her.

Ans: A, C, E Feedback: Health-care professionals respect the wishes of a client who does not wish to be hospitalized and treated unless clients are a danger to themselves or others (i.e., they are threatening or have attempted suicide or represent a danger to others). When a client states that he or she intends to commit suicide and is making plans to do so, the client is threatening suicide and could be subjected to involuntary hospitalization. When a client does not bathe regularly or change clothes often, the client is neglecting his or her hygiene, but it is unlikely that this could be construed as an imminent risk of harm to self. When a client states that he or she intends to harm others by a deliberate act, the client could be considered representing a danger to others. When a client who has diabetes refuses to follow the prescribed diet, the client is acting within his or her own right to comply with the recommendations of their health-care provider. When a client is unable to control his or her rage and is assaulting everyone around him or her, the client would be considered a danger to others.

Which of the following are criteria that must be adhered to when instituting the shortterm use of restraint or seclusion? Select all that apply. A) The client is aggressive. B) The client is being punished. C) The client is imminently dangerous to himself or herself or to others. D) The client is physically and emotionally self-controlled. E) All other means of calming the client have been unsuccessful.

Ans: A, C, E Feedback: Short-term use of restraint or seclusion is permitted only when the client is imminently aggressive and dangerous to himself or herself or to others, and all other means of calming the client have been unsuccessful. The nurse must frequently contact the client and reassure the client that restraint is a restorative, not a punitive, procedure. If the client is physically and emotionally self-controlled, there is no reason for the client to be restrained or secluded.

Which of the following are critical components in assessment of a person's grief? Select all that apply. A) Adequate perception regarding the loss B) Adequate time to experience the loss C) Adequate support while grieving for the loss D) Adequate opportunities to say goodbye to the person E) Adequate coping behaviors during the process

Ans: A, C, E Feedback: While observing for client responses in the dimensions of grieving, the nurse explores three critical components in assessment: ï Adequate perception regarding the loss ï Adequate support while grieving for the loss ï Adequate coping behaviors during the process The time to experience the loss varies significantly from person to person, and the reality is that there may not be adequate opportunities to say goodbye to the person

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

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

Which of the following are important issues for nurses to be aware of when working with angry, hostile, or aggressive clients? Select all that apply. A) Nurses must be aware of their own feelings about anger and their use of assertive communication and conflict resolution. B) Nurses must not allow themselves to become angry under any circumstances. C) Nurses must know that a client's anger or aggressive behavior is preventable by a skilled nurse. D) Nurses must discuss situations or the care of potentially aggressive clients with experienced nurses. E) Nurses must be calm, nonjudgmental, and nonpunitive when using techniques to control a client's aggressive behavior.

Ans: A, D, E

The nurse is educating a client and family about managing panic attacks after discharge from treatment. The nurse includes which of the following in the discharge teaching? Select all that apply. A) Continued development of positive coping skills B) Weaning off of medications as necessary C) Lessening the amount of daily responsibilities D) Continued practice of relaxation techniques E) Development of a regular exercise program

Ans: A, D, E Feedback: Client/family education for panic disorder includes reviewing breathing control and relaxation techniques, discussing positive coping strategies, encouraging regular exercise, emphasizing the importance of maintaining prescribed medication regimen and regular follow-up, describing time management techniques such as creating ìto doî lists with realistic estimated deadlines for each activity, crossing off completed items for a sense of accomplishment, saying ìno,î and stressing the importance of maintaining contact with community and participating in supportive organizations. Medication should be adhered to as prescribed. Daily responsibilities cannot be avoided, rather should be successfully accomplished.

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

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

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

Ans: B Feedback: Acceptance is avoiding judgments of the person, no matter what the behavior is. It means accepting the person but not necessarily the behavior. It does not involve punishment for inappropriate behavior. Empathy is the ability of the nurse to perceive the meanings

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

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

The nurse reviews results of the Minnesota Multiphasic Personality Inventory (MMPI) recorded in a patient record. While considering the usefulness of these data, the nurse is mindful that the MMPI has which limitation? A) The patient must be able to read to complete the MMPI. B) The results of the MMPI could be culturally biased. C) The MMPI assesses a narrow scope of functioning. D) The MMPI does not have established validity

Ans: B Feedback: Both intelligence tests and personality tests are frequently criticized as being culturally biased. It is important to consider the client's culture and environment when evaluating the importance of scores or projections from any of these tests. Objective personality tests compare the client's answers with standard answers or criteria and obtain a score or scores. The MMPI provides scores on 10 clinical scales such as hypochondriasis, depression, hysteria, and paranoia; four special scales such as anxiety and alcoholism; three validity scales to evaluate the truth and accuracy of responses.

A nurse and a client of Chinese heritage are collaborating on treatment goals. The nurse would document which of the following as the client's priority goal? A) The client will be free of pain and excess stress. B) The client will express a feeling of balance and harmony. C) The client will be free of physical symptoms of illness. D) The client will express gratefulness to God for recovery.

Ans: B Feedback: Chinese and many other Asian cultures view health as a balance of body, mind, and spirit. Pain-free is a major focus of African American culture. Russians and Latino cultures focus largely on physical aspects of health. Arab cultures view health as a gift of God.

A client made threats to harm his parents if they come too close to him. The parents called 911, and the client is now held involuntarily for a psychiatric evaluation. During this time of involuntary admission, the client retains all client rights except for which of the following? A) Confidentiality B) Right to freedom C) Periodic treatment review D) Choice of providers

Ans: B Feedback: Civil commitment or involuntary hospitalization curtails the client's right to freedom (the ability to leave the hospital when he or she wishes). All other client rights, however, remain intact

Which is most likely to be the subject of an aggressive attack from a client with mental illness? A) Other people B) The client C) Animals

Ans: B Feedback: Clients with psychiatric disorders are more likely to hurt themselves than other people.

Which of the following would not be included as a symptom of drug-induced parkinsonism? A) Stooped posture B) Cogwheel rigidity C) Drooling D) Tachycardia

Ans: D Feedback: Bradycardia (not tachycardia), a stooped posture, cogwheel rigidity, and drooling are all symptoms of pseudoparkinsonism. Other symptoms of pseudoparkinsonism include mask-like facies, decreased arm swing, a shuffling, festinating gait, tremor, and coarse pill-rolling movements of the thumb and fingers while at rest.

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

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

When the client experiences facial flushing, a throbbing headache, nausea and vomiting after consuming alcohol while taking Disulfiram (Antabuse), the nurse is aware that this is due to which of the following? A) A mild side effect of the medication. B) The intended therapeutic result. C) An idiosyncratic reaction D) A severe allergy to the medication

Ans: B Feedback: Disulfiram is a sensitizing agent that causes an adverse reaction when mixed with alcohol in the body. Five to ten minutes after a person taking disulfiram ingests alcohol, symptoms begin to appear: facial and body flushing from vasodilation, a throbbing headache, sweating, dry mouth, nausea, vomiting, dizziness, and weakness. These symptoms are not mild side effects because these are very uncomfortable symptoms. These symptoms would not be an idiosyncratic reaction because this is the expected reaction. These symptoms are not indicative of a severe allergy to the medication.

When the client experiences facial flushing, a throbbing headache, nausea and vomiting after consuming alcohol while taking Disulfiram (Antabuse), the nurse is aware that this is due to which of the following? A) A mild side effect of the medication. B) The intended therapeutic result. C) An idiosyncratic reaction D) A severe allergy to the medication.

Ans: B Feedback: Disulfiram is a sensitizing agent that causes an adverse reaction when mixed with alcohol in the body. Five to ten minutes after a person taking disulfiram ingests alcohol, symptoms begin to appear: facial and body flushing from vasodilation, a throbbing headache, sweating, dry mouth, nausea, vomiting, dizziness, and weakness. These symptoms are not mild side effects because these are very uncomfortable symptoms. These symptoms would not be an idiosyncratic reaction because this is the expected reaction. These symptoms are not indicative of a severe allergy to the medication.

A client is observed pacing the hall with clenched fists and swearing at others. The nurse intervenes immediately to prevent the client from moving to which phase of the aggressing cycle? A) Triggering B) Escalation C) Crisis D) Recovery

Ans: B Feedback: During escalation, the client's responses represent escalating behaviors that indicate movement toward a loss of control, including pale or flushed face, yelling, swearing, agitated, threatening, demanding, clenched fists, threatening gestures, hostility, loss of ability to solve the problem or think clearly. This phase is followed by the crisis phase. During a period of emotional and physical crisis, the client loses control. Behaviors may include loss of emotional and physical control, throwing objects, kicking, hitting, spitting, biting, scratching, shrieking, screaming, and inability to communicate clearly.

Several family members arrive to visit an African American client. The nurse can best meet this client's need for socialization by providing the client and family which of the following? A) Individual visits to provide the client with a calm environment B) Group gatherings and open conversation C) Inclusion of ritualistic health practices with the family present D) A spiritual healer to remove the illness and protect the family

Ans: B Feedback: During illness, families are often a support system for the sick person. Families often feel comfortable demonstrating public affection such as hugging and touching one another. Conversation among family and friends may be animated and loud. Spiritual rituals are more prevalent in Native American cultures

The client's son is yelling and is hitting his hand with a rolled up newspaper. Which stage of aggression does the nurse identify that the client's son is exhibiting? A) Triggering B) Escalation C) Crisis D) Recovery

Ans: B Feedback: During the escalation phase of aggression, a person may exhibit yelling and threatening, clenched fist, threatening gestures. During the triggering phase of aggression, a person may exhibit signs and symptoms and behaviors including restlessness, anxiety, irritability, pacing, muscle tension, rapid breathing, perspiration, loud voice, and anger.

The nurse is teaching a client to recognize early signs of anger and aggression. The nurse explores ways that the client can recognize which of the following? A) Decreased problem-solving ability B) Restlessness and irritability C) Remorse D) Severe muscle tension

Ans: B Feedback: Earliest signs of anger include restlessness, anxiety, irritability, pacing, muscle tension, rapid breathing, perspiration, loud voice, and anger. Escalated signs include pale or flushed face, yelling, swearing, agitation, threatening, demanding, increased muscle tension such as clenched fists, threatening gestures, hostility, and loss of ability to solve the problem

Which of the following statements about posttraumatic stress disorder is accurate? A) Estimates are that the disorder is very rare. B) Estimates are that up to 60% of people at risk develop PTSD. C) Only 20% of victims of rape develop PTSD. D) PTSD symptoms usually begin at the time of the traum

Ans: B Feedback: Estimates are that up to 60% of people at risk develop PTSD.

A malpractice lawsuit was filed after a nurse restrained the client for screaming at and attempting to strike anyone who was within striking distance. The nurse followed agency procedures that were consistent with Joint Commission Standards. For which reason is this malpractice lawsuit most likely to be unsuccessful? A) The nurse did not have a duty. B) The nurse did not breach duty. C) The client did not suffer some type of loss, damage, or injury. D) There was no evidence that a breach of duty was a direct cause of the loss, damage, or injury.

Ans: B Feedback: For a malpractice suit to be successful, the client or family needs to prove the following four elements: (1) Duty: a legally recognized relationship (i.e., physician to client, nurse to client) existed. The nurse had a duty to the client, meaning that the nurse was acting in the capacity of a nurse. (2) Breach of duty: the nurse (or physician) failed to conform to standards of care, thereby breaching or failing the existing duty. The nurse did not act as a reasonable, prudent nurse would have acted in similar circumstances. (3) Injury or damage: the client suffered some type of loss, damage, or injury. (4) Causation: the breach of duty was the direct cause of the loss, damage, or injury. In other words, the loss, damage, or injury would not have occurred if the nurse had acted in a reasonable, prudent manner. The nurse did have a duty to the client. The nurse did not breach this duty by the nursing actions. The client did experience loss of autonomy from being restrained. Since there was no breach of duty, there was no evidence that a breach of duty was a direct cause of the loss, damage, or injury.

Which of the following is an inhibitory neurotransmitter? A) Dopamine B) GABA C) Norepinephrine D) Epinephrine

Ans: B Feedback: GABA is the major inhibitory neurotransmitter in the brain and has been found to modulate other neurotransmitter systems rather than to provide a direct stimulus. Dopamine, norepinephrine, and epinephrine are excitatory neurotransmitters.

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

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

In the psychiatric setting, what is the most effective intervention in preventing the hostile client's behavior from escalating to physical aggression? A) Getting as far away from him or her as possible B) Engaging the hostile person in dialogue C) Yelling at the client to settle down now D) Ensuring that the client gets his or her way

Ans: B Feedback: In a psychiatric setting, engaging the hostile person is most effective to prevent the behavior from escalating to physical aggression. In the psychiatric setting, it is not possible to get as far away from them as possible. Yelling at the client will likely escalate the hostility. Ensuring that the client gets his or her way may eliminate frustration that may lead to acting out, but is unrealistic and not ultimately helpful to the client.

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

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

Which of the following is a term used to describe the occurrence of the eye rolling back in a locked position, which occurs with acute dystonia? A) Opisthotonus B) Oculogyric crisis C) Torticollis D) Pseudoparkinsonism

Ans: B Feedback: Oculogyric crisis is the occurrence of the eye rolling back in a locked position, which occurs with acute dystonia. Opisthotonus is tightness in the entire body with the head back and an arched neck. Torticollis is twisted head and neck. Oculogyric crisis, opisthotonus, and torticollis are manifestations of acute dystonia. Pseudoparkinsonism is drug-induced parkinsonism

The client identifies anger management as a problem. What is the next step in planning therapeutic interactions? A) Give the client a variety of choices on how to express anger. B) Give the client permission to be angry. C) Point out the senselessness of anger. D) Tell the client not to be angry all the time

Ans: B Feedback: Many people view anger as a negative and abnormal feeling in addition to feeling guilty about being angry; the nurse can help the client see anger as a normal, acceptable emotion. Giving choices on how to express anger would not be the next step in the planning stage. Pointing out the senselessness of anger and telling the client not to be angry all the time are not appropriate responses in this situation.

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

Ans: B Feedback: Mental illness includes general dissatisfaction with self, ineffective relationships, ineffective coping, and lack of personal growth. Additionally the behavior must not be culturally expected. Acute grief reactions are expected and therefore not considered mental illness. False reassurance or overanalysis does not accurately address the client's concerns.

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

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

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

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

A nurse is leading a medication education group for patients with depression. A patient states he has read that herbal treatments are just as effective as prescription medications. The best response is, A) ìWhen studies are published they can be trusted to be accurate.î B) ìWe need to look at the research very closely to see how reliable the studies are.î C) ìYour prescribed medication is the best for your condition, so you should not read those studies.î D) ìSwitching medications will alter the course of your illness. It is not advised.î

Ans: B Feedback: Often, reports in the media regarding new research and studies are confusing, contradictory, or difficult for clients and their families to understand. The nurse must ensure that clients and families are well informed about progress in these areas and must also help them to distinguish between facts and hypotheses. The nurse can explain if or how new research may affect a client's treatment or progno

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

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

How should the nurse respond to a family member who asks how Alzheimer's disease is diagnosed? A) It is impossible to know for certain that a person has Alzheimer's disease until the person dies and his or her brain can be examined via autopsy. B) Positron emission tomography (PET) scans can identify the amyloid plaques and tangles of Alzheimer's disease in living clients. C) Alzheimer's disease can be diagnosed by using chemical markers that demonstrate decreased cerebral blood flow. D) It will be necessary for the patient to undergo positron emission tomography (PET) scans regularly for a long period of time to know if the patient has Alzheimer's disease.

Ans: B Feedback: Positron emission tomography (PET) scans can identify the amyloid plaques and tangles of Alzheimer's disease in living clients. These conditions previously could be diagnosed only through autopsy. Some persons with schizophrenia also demonstrate decreased cerebral blood flow. A limitation of PET scans is that the use of radioactive substances limits the number of times a person can undergo these tests

Individuals who grow up in ìat-riskî environments but are able to become productive, successful citizens are believed to possess which of the following characteristics? A) Hardiness B) Resilience C) Social skills D) Tolerance

Ans: B Feedback: Resilience is having healthy responses to stressful situations or risky environments. Hardiness is the ability to resist illness when under stress. Social skills are a type of coping strategy. Tolerance is the ability to deal with increasing levels of stress in an adaptive way.

Which of the following antidepressant drugs is a preferred drug for clients at high risk of suicide? A) Tranylcypromine (Parnate) B) Sertraline (Zoloft) C) Imipramine (Tofranil) D) Phenelzine (Nardil)

Ans: B Feedback: SSRIs, venlafaxine, nefazodone, and bupropion are often better choices for those who are potentially suicidal or highly impulsive because they carry no risk of lethal overdose, in contrast to the cyclic compounds and the MAOIs. Parnate and Nardil are MAOIs. Tofranil is a cyclic compound.

A patient with depression has been taking paroxetine (Paxil) for the last 3 months and has noticed improvement of symptoms. Which of the following side effects would the nurse expect the patient to report? A) A headache after eating wine and cheese B) A decrease in sexual pleasure during intimacy C) An intense need to move about D) Persistent runny nose

Ans: B Feedback: Sexual dysfunction can result from enhanced serotonin transmission associated with SSRI use. Headache caused by hypertension can result when combining MAOIs with foods containing tyramine, such as aged cheeses and alcoholic beverages. SSRIs cause less weight gain than other antidepressants. Dry mouth and nasal passages are common anticholinergic side effects associated with all antidepressants. An intense need to move about (akathisia) is an extrapyramidal side effect that would be expected of an antipsychotic medication. Furthermore, sedation is a common side effect of Paxil

A Filipino client meets the nurse for the first time. The client simply smiles at the nurse when introduced. The nurse interprets this behavior as A) a display of being shy and introverted. B) a typical greeting for a Filipino client. C) constricted verbal skills associated with the client's illness. D) a sign that the client may be suspicious of the nurse.

Ans: B Feedback: Smiles rather than handshakes are a common form of greeting in Pilipino culture. Filipino clients consider direct eye contact impolite, so there is little direct eye contact with authority figures such as nurses and physicians.

Which psychiatric disorder makes a person most susceptible to anger attacks that do not result in physical aggression? A) Delusions B) Depression C) Dementia D) Delirium

Ans: B Feedback: Some clients with depression have anger attacks that are sudden intense spells of anger that typically occur in situation where the depressed person feels emotionally trapped. Anger attacks involve verbal expressions of anger or rage but no physical aggression. Persons with delusions, dementia, and delirium are most likely to become physically aggressive.

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

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

Which of the following would best assess a client's judgment? A) Counting by serial sevens B) Discussing hypothetical situations C) Interpreting proverbs D) Spelling words backward

Ans: B Feedback: The client's judgment can be elicited by asking the client to discuss hypothetical situations, which would indicate one's ability to interpret one's environment and situation correctly and to adapt one's behavior and decisions accordingly. Counting by serial sevens and spelling words backward would assess the client's ability to concentrate. Interpreting proverbs would assess the client's abstract thinking.

Which one of the following types of antipsychotic medications is most likely to produce extrapyramidal effects? A) Atypical antipsychotic drugs B) First-generation antipsychotic drugs C) Third-generation antipsychotic drugs D) Dopamine system stabilizers

Ans: B Feedback: The conventional, or first-generation, antipsychotic drugs are potent antagonists of D2, D3, and D4. This makes them effective in treating target symptoms but also produces many extrapyramidal side effects because of the blocking of the D2 receptors. Newer, atypical or second-generation antipsychotic drugs are relatively weak blockers of D2, which may account for the lower incidence of extrapyramidal side effects. The third generation of antipsychotics, called dopamine system stabilizers, is being developed. These drugs are thought to stabilize dopamine output that results in control of symptoms without some of the side effects of other antipsychotic medications.

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

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

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

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

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

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

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

Ans: B Feedback: Therapeutic communication techniques, such as reflection, restatement, and clarification, help the nurse to send empathetic messages to the client. The nurse must understand the difference between empathy and sympathy (feelings of concern or compassion one shows for another). Sympathy often shifts the emphasis to the nurse's feelings, hindering the nurse's ability to view the client's needs objectively.

The nurse is conducting a history and physical exam on a client who is grieving the unwanted loss of a marriage by divorce. Which of the following physical symptoms of grief would the nurse most likely expect to detect in the history? A) Headaches B) Insomnia C) Weight loss D) GI upset

Ans: B Feedback: Those grieving may complain of insomnia, headaches, impaired appetite, weight loss, lack of energy, palpitations, indigestion, and changes in the immune and endocrine systems. Sleep disturbances are among the most frequent and persistent bereavementassociated symptoms.

A young couple just ended their relationship after a 9-month engagement. The one of the individuals is seeking short-term counseling to assist in grieving this loss. Which type of loss best describes what this client is experiencing? A) Safety loss B) Loss of security and sense of belonging C) Loss of self-esteem D) Loss related to self-actualization

Ans: B Feedback: Types of loss include safety loss (loss of a safe environment), loss of security and a sense of belonging (loss of a loved one affects the need to love and the feeling of being loved), loss of self-esteem (any change in how a person is valued at work or in relationships or by him or herself), or loss related to self-actualization (external or internal crisis that blocks or inhibits strivings toward fulfillment).

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

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

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

Ans: B Feedback: When the nurse states, ìIt would be unusual for anyone to have that kind of power,î the nurse is voicing doubt or expressing uncertainty about the reality of the client's perceptions.

It is recorded in the client's chart that the family is resilient. The nurse concludes which of the following characteristics about the family life of this client? Select all that apply. A) Family members are independent of one another. B) Family members spend time together. C) Family members engage in recreational activities together. D) Family members share the same personal goals. E) Family members allow individual members to develop unique daily routines.

Ans: B, C Feedback: Factors that are present in resilient families include positive outlook, spirituality, family member accord, flexibility, family communication, and support networks. Resilient families also spend time together, share recreational activities, and participate in family rituals and routines together. Personal goal setting reflects self-efficacy.

Which of the following are interpersonal theories regarding the etiologies of major anxiety disorders? Select all that apply. A) Sigmund Freud's theory B) Henry Stack Sullivan's theory C) Hildegard Peplau's theory D) Pavlov's theory

Ans: B, C Feedback: Theories of anxiety can be classified as intrapsychic/psychoanalytic theories, interpersonal theories, and behavioral theories. Freud's intrapsychic theory views a person's innate anxiety as the stimulus for behavior. Interpersonal theories include Sullivan's theory that anxiety is generated from problems in interpersonal relationships and Peplau's belief that humans exist in interpersonal and physiologic realms. Behavioral theorists view anxiety as being learned through experiences.

Which of the following losses are likely to result in disenfranchised grief? Select all that apply. A) A young adult whose spouse has just died suddenly B) A family whose long-time pet snake has just died C) A nurse who has just witnessed the death of a patient D) A couple who has just experienced pregnancy loss E) The gay lover of a man who just died from AIDS F) The mother and sister of a soldier who was killed in war

Ans: B, C, D, E

Which of the following might the nurse recognize as longer-term responses to trauma and stress? Select all that apply. A) Acute stress disorder B) Posttraumatic stress disorder C) Adjustment disorder D) Reactive attachment disorder E) Dissociative disorde

Ans: B, C, D, E Feedback: Acute stress disorder usually occurs from 2 days to 4 weeks after a trauma. Posttraumatic stress disorder usually begins 3 months after the trauma. All of the rest of these are longer-term responses to trauma and stress

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

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

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

Ans: B, C, D, E Feedback: The nurse who feels sorry for the client often tries to compensate by trying to please him or her. When the nurse's behavior is rooted in sympathy, the client finds it easier to manipulate the nurse's feelings. This discourages the client from exploring his or her problems,

The nurse is educating a patient and family about strategies to minimize the side effects of antipsychotic drugs. Which of the following should be included in the plan? Select all that apply. A) Drink plenty of fruit juice. B) Developing an exercise program is important. C) Increase foods high in fiber. D) Laxatives can be used as needed. E) Use sunscreen when outdoors. F) For missed doses, take double the dose at the next scheduled time

Ans: B, C, E Feedback: Drinking sugar-free fluids and eating sugar-free hard candy ease dry mouth. The client should avoid calorie-laden beverages and candy because they promote dental caries, contribute to weight gain, and do little to relieve dry mouth. Methods to prevent or relieve constipation include exercising and increasing water and bulk-forming foods in the diet. Stool softeners are permissible, but the client should avoid laxatives. The use of sunscreen is recommended because photosensitivity can cause the client to sunburn easily. If the client forgets a dose of antipsychotic medication, he or she can take the missed dose if it is only 3 or 4 hours late. If the dose is more than 4 hours overdue or the next dose is due, the client can omit the forgotten dose.

Which of the following individual factors can a person modify to improve mental and emotional health? Select all that apply. A) Serotonin deficiency B) Lack of exercise C) Poor nutrition D) Type I diabetes E) Sleeplessness

Ans: B, C, E Feedback: Personal health practices, such as exercise, poor nutritional status, lack of sleep, or a chronic physical illness, can influence the client's response to illness. Unlike genetic factors, how a person lives and takes care of himself or herself can alter many of these factors. For this reason, nurses must assess the client's physical health even when the client is seeking help for mental health problems. Serotonin deficiency and type I diabetes are not under voluntary control.

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

Ans: B, C, E Feedback: The therapeutic relationship focuses on the needs, experiences, feelings, and ideas of the client only. In the therapeutic relationship, the parameters are clear: the focus is the client's needs, not the nurse's. The nurse should not be concerned about whether or not the client likes him or her or is grateful. A social relationship is focuses on sharing ideas, feelings, and experiences and meets the basic need for people to interact. In social relationships, advice is often given. This should be avoided in therapeutic relationships

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

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

Which of the following would the nurse know are the major elements of posttraumatic stress disorder (PTSD)? Select all that apply. A) Trying to avoid any places or people or situations that may trigger memories of the trauma B) Reexperiencing the trauma through dreams or recurrent and intrusive thoughts C) Becoming increasingly more isolated D) Emotional numbing such as feeling detached from others E) Being on guard, irritable, or experiencing hyperarousal

Ans: B, D, E Feedback: The three major elements of PTSD are reexperiencing the trauma through dreams or recurrent and intrusive thoughts, showing emotional numbing such as feeling detached from others, and being on guard, irritable, or experiencing hyperarousal. The client may also experience a numbing of general responsiveness and may try to avoid any places or people or situations that may trigger memories of the trauma, but these are not the major elements of PTSD

Which of the following side effects of lithium are frequent causes of noncompliance? Select all that apply. A) Metallic taste in the mouth B) Weight gain C) Acne D) Thirst E) Lethargy

Ans: B, E Feedback: Lethargy and weight gain are difficult to manage or minimize and frequently lead to noncompliance

Which of the following statements about hope and symptoms of mental illness are true? Select all that apply. A) Hope is not realistic and therefore is not related to mental well-being. B) Persons having more hope experienced fewer actual symptoms. C) Hope is a cause of mental illness. D) There is not a significant relationship between hopelessness and increased symptoms. E) A possible way to help clients manage and decrease symptoms would be to support the development of hope

Ans: B, E Feedback: Persons having more hope experienced fewer actual symptoms. A significant relationship between hopelessness and increased symptoms was also demonstrated. This may indicate that one of the ways to help clients manage and decrease symptoms is having a wellness plan that includes a positive future outlook and support for the development of hope.

The most effective way for the nurse to provide culturally competent care to individuals who are grieving is which of the following? A) Understand the practices associated with a client's culture. B) Suggest developing a new ritual to make mourning meaningful. C) Ask the client what rituals are personally meaningful. D) Contact a spiritual leader from the client's culture to become involved.

Ans: C Feedback: Rather than assuming that he or she understands a particular culture's grieving behaviors, the nurse must encourage clients to discover and use what is effective and meaningful to them.

he nurse is assessing the anxiety level of a young school-age child. The nurse encourages the child to express feelings through the use of toys in a play situation. The purpose for this approach to assessment is largely related to which of the following? A) The child has cognitive impairment and has limited vocabulary skills. B) The child has not been intellectually stimulated and can only express self through play. C) Children may not have developed the language to fully describe their feelings. D) Children will not express themselves openly unless instructed to do so by parents.

Ans: C Feedback: A client's age can influence how he or she expresses illness. A young child may lack the understanding and ability to describe his or her feelings, which may make management of the disorder more challenging. Nurses must be aware of the child's level of language and work to understand the experience as he or she describes it.

Kubler-Ross developed a model of five stages to explain what people experience as they grieve and mourn. Which is stage V of Kubler-Ross's stages of grieving? A) Denial B) Bargaining C) Acceptance D) Anger

Ans: C Feedback: Acceptance occurs when the person shows evidence of coming to terms with death. Denial is shock and disbelief regarding the loss. Bargaining occurs when the person asks God or fate for more time to delay the inevitable loss. Anger may be expressed toward God, relatives, friends, or health-care providers.

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

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

Females from which of the following cultures are most likely to be expected to move in with husband's family? A) African Americans B) Mexican Americans C) South Asians D) Haitians

Ans: C Feedback: African Americans are more likely to have a nuclear family. Mexican Americans mostly live in nuclear families. South Asians expect the daughters to move in with the husband's family. Haitians may have an extended or a nuclear family.

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

Ans: C Feedback: Although people with severe and persistent mental illness have shorter hospital stays, they are admitted to hospitals more frequently. Although deinstitutionalization reduced the number of public hospital beds by 80%, the number of admissions to those beds correspon

A nurse is working with a Middle-Eastern client being treated for major depression. The client is expressing feelings of guilt for not being able to ìsnap out of it.î A therapeutic response by the nurse would be, A) ìYou have to keep trying to feel better.î B) ìWhat do you think could have caused your depression?î C) ìClinical depression is not something you have brought on yourself.î D) ìIt will take several weeks for your medicine to start to help you feel better.î

Ans: C Feedback: Arab Americans believe mental illness is something the person can control. Educating about the etiology reduces the guilt associated with having an illness. Suggesting the client keep trying or caused the depression in some way implies that the client is responsible for the illness. Informing about medication ignores the client's feelings of guilt.

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

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

Which of the following was the first nonstimulant medication specifically designed and tested for ADHD? A) Methylphenidate (Ritalin) B) Amphetamine (Adderall) C) Atomoxetine (Strattera) D) Pemoline (Cylert)

Ans: C Feedback: Strattera was the first nonstimulant medication specifically designed and tested for ADHD. The primary stimulant drugs used to treat ADHD are methylphenidate (Ritalin), amphetamine (Adderall), and pemoline (Cylert).

What a culture considers acceptable strongly influences the expression of anger. Which culture-bound syndrome is a dissociative episode characterized by a period of brooding followed by an outburst of violent, aggressive, or homicidal behavior directed at other people and objects? A) Hwa-Byung B) Hwabyeong C) Amok D) BouffÈe delirante

Ans: C Feedback: BouffÈe delirante, a condition observed in West Africa and Haiti, is characterized by a sudden outburst of agitated and aggressive behavior, marked confusion, and psychomotor excitement. Hwa-Byung or hwabyeong is a culture-bound syndrome that literally translates as anger syndrome, or fire illness, attributed to the suppression of anger. Amok is a dissociative episode characterized by a period of brooding followed by an outburst of violent, aggressive, or homicidal behavior directed at other people and objects.

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

Ans: C Feedback: Clients can remain in their communities, maintain contact with family and friends, and enjoy personal freedom that is not possible in an institution. Full-time home care is not included in community-based programs

A client who had agreed to be hospitalized for depression problems has decided that now she wants to leave the hospital. The mental health staff caring for her realizes that at present she can legally A) be discharged if evaluated through administrative hearings. B) be retained in the hospital against her will. C) leave the hospital after giving written notice of her intent to do so. D) leave without discussing the situation with anyone

Ans: C Feedback: Clients who are not dangerous to themselves or others can leave the hospital against medical advice. The other choices are not appropriate

Which of the following increases the risk for neuroleptic malignant syndrome (NMS)? A) Overhydration B) Intake of vitamins C) Dehydration D) Vegetarian diet

Ans: C Feedback: Dehydration, poor nutrition, and concurrent medical illness all increase the risk for NMS. Overhydration is opposite of dehydration and would therefore not increase the risk of NMS. Intake of vitamins would likely reduce the risk of NMS as it would improve nutritional status. Vegetarian diet would not relate to NMS.

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

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

Which of the following is the primary consideration with clients taking antidepressants? A) Decreased mobility B) Emotional changes C) Suicide D) Increased sleep

Ans: C Feedback: Suicide is always a primary consideration when treating clients with depression.

A client who has depression is admitted to treatment on a voluntary basis. While in the hospital, the client makes several comments about wanting to ìend it all.î The client decides one day to leave against medical advice. Which of the following would be the most appropriate action by the nursing staff? A) Calling security and asking them to detain the client B) Allowing the client to leave with community resources for follow-up care C) Contacting the psychiatrist for initiation of commitment proceedings D) Contacting the client's family to request they convince the client to stay

Ans: C Feedback: If a voluntary client who is dangerous to himself or herself or to others signs a request for discharge, the psychiatrist may file for a civil commitment to detain the client against his or her will until a hearing can take place to decide the matte

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

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

The student nurse correctly identifies that according to Selye (1956, 1974), which stage of reaction to stress stimulates the body to send messages from the hypothalamus to the glands and organs to prepare for potential defense needs? A) Resistance B) Exhaustion C) Alarm reaction D) Autonomic

Ans: C Feedback: In the alarm reaction stage, stress stimulates the body to send messages from the hypothalamus to the glands and organs to prepare for potential defense needs. In the resistance stage, the digestive system reduces function to shunt blood to areas needed for defense. The exhaustion stage occurs when the person has responded negatively to anxiety and stress. There is no autonomic stage.

At which point in the stages of aggressive incidents is intervention least likely to be effective in preventing physically aggressive behavior? A) Triggering B) Escalation C) Crisis D) Postcrisis

Ans: C Feedback: Interventions during the triggering and escalation phases are key to prevent physically aggressive behavior. During the crisis phase, behavior escalation may lead to physical aggression. During the postcrisis phase, the physically aggressive behavior has stopped and the client returns to the level of functioning before the aggressive incident.

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

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

A patient with bipolar disorder takes lithium 300 mg three times daily. The nurse evaluates that the dose is appropriate when the patient reports A) feeling sleepy and less energetic. B) weight gain of 7 pounds in the last 6 months. C) minimal mood swings. D) increased feelings of self-wor

Ans: C Feedback: Mood-stabilizing drugs are used to treat bipolar disorder by stabilizing the client's mood, preventing or minimizing the highs and lows that characterize bipolar illness, and treating acute episodes of mania. Weight gain is a common side effect, and fatigue and lethargy may indicate mild toxicity. Inflated self-worth is a target symptom of bipolar disorder, which should diminish with effective treatment

A patient with bipolar disorder takes lithium 300 mg three times daily. The nurse evaluates that the dose is appropriate when the patient reports A) feeling sleepy and less energetic. B) weight gain of 7 pounds in the last 6 months. C) minimal mood swings. D) increased feelings of self-worth.

Ans: C Feedback: Mood-stabilizing drugs are used to treat bipolar disorder by stabilizing the client's mood, preventing or minimizing the highs and lows that characterize bipolar illness, and treating acute episodes of mania. Weight gain is a common side effect, and fatigue and lethargy may indicate mild toxicity. Inflated self-worth is a target symptom of bipolar disorder, which should diminish with effective treatment

In the space of 5 minutes, the client has been laughing and euphoric, then angry, and then crying for no reason that is apparent to the nurse. This behavior would be best described as A) flight of ideas. B) lack of insight. C) labile mood. D) tangential thinking.

Ans: C Feedback: Moods that shift rapidly, displaying a range of emotions, are termed labile. Flight of ideas is manifested by excessive amount and rate of speech composed of fragmented or unrelated ideas. Lack of insight would be manifested by the lack of the ability to understand the true nature of one's situation and accept some personal responsibility for that situation. Tangential thinking would be manifested by wandering off the topic and never providing the information requested

Direct eye contact is preferred by which of the following cultures? A) Native Americans B) Cambodians C) Russians D) Chinese

Ans: C Feedback: Of these cultures, only Russians prefer direct eye contact. Native Americans communicate respect by avoiding eye contact. For Cambodians, eye contact is acceptable, but ìpoliteî women lower their eyes. For Chinese, eye contact is avoided with authority figures.

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

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

A patient is seen for frequent exacerbation of schizophrenia due to nonadherence to medication regimen. The nurse should assess for which of the following common contributors to nonadherence? A) The patient is symptom-free and therefore does not need to adhere to the medication regimen. B) The patient cannot clearly see the instructions written on the prescription bottle. C) The patient dislikes the weight gain associated with antipsychotic therapy. D) The patient sells the antipsychotics to addicts in the neighborhood.

Ans: C Feedback: Patients with schizophrenia are less likely to exercise or eat low-fat nutritionally balanced diets; this pattern decreases the likelihood that they can minimize potential weight gain or lose excess weight. Antipsychotics should be taken regularly and not omitted when free of symptoms. Antipsychotics do not adversely affect vision, nor do they have addictive potential.

The nurse has completed health teaching about dietary restrictions for a client taking a monoamine oxidase inhibitor. The nurse will know that teaching has been effective by which of the following client statements? A) ìI'm glad I can eat pizza since it's my favorite food.î B) ìI must follow this diet or I will have severe vomiting.î C) ìIt will be difficult for me to avoid pepperoni.î D) ìNone of the foods that are restricted are part of a regular daily diet.î

Ans: C Feedback: Pepperoni is one of the foods containing tyramine, so it must be avoided. Particular concern to this client is the potential life-threatening hypertensive crisis if the client ingests food that contains tyramine. Answer choices A, B, and D are inappropriate statements toward effective teaching for the client receiving a monoamine oxidase inhibitor.

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

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

A client who is taking paroxetine (Paxil) reports to the nurse that he has been nauseated since beginning the medication. Which of the following actions is indicated initially? A) Instruct the client to stop the medication for a few days to see if the nausea goes away. B) Reassure the client that this is an expected side effect that will improve with time. C) Suggest that the client take the medication with food. D) Tell the client to contact the physician for a change in medication.

Ans: C Feedback: Taking selective serotonin reuptake inhibitors with food usually eliminates nausea. There is a delayed therapeutic response to antidepressants. The client should not stop taking the drug. It would be appropriate to reassure the client that this is an expected side effect that will improve with time, but that would not be done initially. A change in medication may be indicated if the nausea is intolerable or persistent, but that would not be done initially.

One week after beginning therapy with thiothixene (Navane), the client demonstrates muscle rigidity, a temperature of 103∞F, an elevated serum creatinine phosphokinase level, stupor, and incontinence. The nurse should notify the physician because these symptoms are indicative of A) acute dystonic reaction. B) extrapyramidal side effects. C) neuroleptic malignant syndrome. D) tardive dyskinesia.

Ans: C Feedback: The client demonstrates all the classic signs of neuroleptic malignant syndrome. Dystonia involves acute muscular rigidity and cramping, a stiff or thick tongue with difficulty swallowing, and, in severe cases, laryngospasm and respiratory difficulties. Extrapyramidal side effects are reversible movement disorders induced by antipsychotic or neuroleptic medication. Tardive dyskinesia is a late-onset, irreversible neurologic side effect of antipsychotic medications characterized by abnormal, involuntary movements, such as blinking, chewing, and grimacing.

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

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

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

Ans: C Feedback: The nurse's response must let the client know in clear terms that the relationship is professional while not demeaning or ridiculing the client. The other choices would not be appropriate replies in this situation.

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

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

Which one of the following drugs should the nurse expect the patient to require serum level monitoring? A) Anticonvulsants B) Wellbutrin C) Lithium D) Prozac

Ans: C Feedback: Toxicity is closely related to serum lithium levels and can occur at therapeutic doses. For clients taking lithium and the anticonvulsants, monitoring blood levels periodically is important

Beliefs about the causes of pain and illness vary among cultures. In the United States (Western culture), pain and illness are generally attributed to A) economic class. B) psychological influences. C) physiologic causes. D) sociocultural factors.

Ans: C Feedback: Usually, Americans believe that pain and illness arise from physical causes. Two prevalent types of beliefs about what causes illness in non-Western cultures are natural and unnatural or personal. Unnatural or personal beliefs attribute the causes of illness to the active, purposeful intervention of an outside agent, spirit, or supernatural force or deity. The natural view is rooted in a belief that natural conditions or forces, such as cold, heat, wind, or dampness, are responsible for illness.

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

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

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

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

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

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

A client has a lithium level of 1.2 mEq/L. Which of the following interventions by the nurse is indicated? A) Call the physician for an increase in dosage. B) Do not give the next dose, and call the physician. C) Increase fluid intake for the next week. D) No intervention is necessary at this time

Ans: D Feedback: The lithium level is within the therapeutic range. Serum levels of less than 0.5 mEq/L are rarely therapeutic, and a level of more than 1.5 mEq/L is usually considered toxic. Answers A, B, and C are not appropriate interventions for the given lithium level.

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

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

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

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

A woman has just been served divorce papers from her husband. She has no financial resources and little social support. She states, ìHe's not really leaving. He'll be back.î The most appropriate response by the nurse would be which of the following? A) ìHas he done this before?î B) ìI'll call social services and get you signed up for financial assistance.î C) ìYou have to face reality. Here are the papers.î D) ìHow is this affecting you right now?î

Ans: D Feedback: Adaptive denial, in which the client gradually adjusts to the reality of the loss, can help the client let go of previous (before the loss) perceptions while creating new ways of thinking about himself or herself, others, and the world. While taking in the loss in its entirety all at once seems overwhelming, gradually dealing with the loss in smaller increments seems much more manageable. Help the client shift from an unconscious mechanism of denial to conscious coping with reality by using reflective communication skills.

Culture has the most influence on a person's health beliefs and practices. African Americans believe that the cause of mental illness occurs because of which of the following? A) Lack of harmony of emotions B) Supernatural causes C) Heredity D) Lack of spiritual balance

Ans: D Feedback: African Americans believe that mental illness is caused by lack of spiritual balance. Chinese believe that mental illness is caused by lack of harmony of emotions. Haitians believe that mental illness is caused by supernatural causes. Cubans believe that mental illness is hereditary

A client is seen in the clinic with clinical manifestations of an inability to sit still and a rigid posture. These side effects would be correctly identified as which of the following? A) Tardive dyskinesia B) Neuroleptic malignant syndrome C) Dystonia D) Akathisia

Ans: D Feedback: Akathisia is reported by the client as an intense need to move about. The client appears restless or anxious and agitated, often with a rigid posture or gain and a lack of spontaneous gestures. The symptoms of tardive dyskinesia (TD) include involuntary movements of the tongue, facial and neck muscles, upper and lower extremities, and truncal musculature. Tongue thrusting and protruding, lip smacking, blinking, grimacing, and other excessive unnecessary facial movements are characteristic. Neuroleptic malignant syndrome is a potentially fatal reaction manifested by rigidity, high fever, and autonomic instability. Acute dystonia includes acute muscular rigidity and cramping, a stiff or thick tongue with difficulty swallowing, and, in severe cases, laryngospasm and respiratory difficulties

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

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

Which drug classification is the primary medication treatment for schizophrenia? A) Anticoagulants B) Antidepressants C) Antimanics D) Antipsychotics

Ans: D Feedback: Antipsychotic drugs are the primary medical treatment for clients diagnosed with schizophrenia and are also used in psychotic episodes of acute mania, psychotic depression, and drug-induced psychosis

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

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

The nurse knows that the client understands the rationale for dietary restrictions when taking MAOI when the client makes which of the following statements? A) ìI am now allergic to foods that are high in the amino acid tyramine such as aged cheese, organ meats, wine, and chocolate.î B) ìCertain foods will cause me to have sexual dysfunction when I take this medication.î C) ìFoods that are high in tyramine will reduce the medication's effectiveness.î D) ìI should avoid foods that are high in the amino acid tyramine such as aged cheese, meats, and chocolate because this drug causes the level of tyramine to go up to dangerous levels.î

Ans: D Feedback: Because the enzyme MAO is necessary to break down the tyramine in certain foods, its inhibition results in increased serum tyramine levels, causing severe, hypertension, hyperpyrexia, tachycardia, diaphoresis, tremulousness, and cardiac dysrhythmias. Taking an MAOI does not confer allergy to tyramine. Sexual dysfunction is a common side effect of MAOIs. There is no evidence that foods high in tyramine will increase sexual dysfunction or reduce the medication's effectiveness.

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

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

For a client taking clozapine (Clozaril), which of the following symptoms should the nurse report to the physician immediately as it may be indicative of a potentially fatal side effect? A) Inability to stand still for 1 minute B) Mild rash C) Photosensitivity reaction D) Sore throat and ma

Ans: D Feedback: Clozapine (Clozaril) produces fewer traditional side effects than do most antipsychotic drugs, but it has the potentially fatal side effect of agranulocytosis. This develops suddenly and is characterized by fever, malaise, ulcerative sore throat, and leukopenia. This side effect may not be manifested immediately and can occur up to 24 weeks after the initiation of therapy. Any symptoms of infection must be investigated immediately. Agranulocytosis is characterized by fever, malaise, ulcerative sore throat, and leukopenia. Mild rash and photosensitivity reaction are not serious side effects.

A patient shows no facial expression when engaging in a game with peers during an outing at a park. The nurse uses which of the following terms when documenting the patient's affect? A) Blunt affect B) Restricted affect C) Broad affect D) Flat affect

Ans: D Feedback: Common terms used in assessing affect include blunted affect: showing little or a slowto- respond facial expression; broad affect: displaying a full range of emotional expressions; flat affect: showing no facial expression; inappropriate affect: displaying a facial expression that is incongruent with mood or situation, often silly or giddy regardless of circ

A patient with bipolar disorder asks the nurse, ìWhy did I get this illness? I don't want to be sick.î The nurse would best respond with, A) ìPeople who develop mental illnesses often had very traumatic childhood experiences.î B) ìThere is some evidence that contracting a virus during childhood can lead to mental disorders.î C) ìSometimes people with mental illness have an overactive immune system.î D) ìWe don't fully understand the cause, but mental illnesses do seem to run in families.î

Ans: D Feedback: Current theories and studies indicate that several mental disorders may be linked to a specific gene or combination of genes, but that the source is not solely genetic; nongenetic factors also play important roles. A compromised immune system could contribute to the development of a variety of illnesses, particularly in populations already genetically at risk. Maternal exposure to a virus during critical fetal development of the nervous system may contribute to mental illness

Which of the following statements about the neurobiologic causes of mental illness is most accurate? A) Genetics and heredity can explain all causes of mental illness. B) Viral infection has been proven to be the cause of schizophrenia. C) There is no evidence that the immune system is related to mental illness. D) Several mental disorders may be linked to genetic and nongenetic factors.

Ans: D Feedback: Current theories and studies indicate that several mental disorders may be linked to a specific gene or combination of genes, but that the source is not solely genetic; nongenetic factors also play important roles. Most studies involving viral theories have focused on schizophrenia, but so far none has provided specific or conclusive evidence. A compromised immune system could contribute to the development of a variety of illnesses, particularly in populations already genetically at risk. So far, efforts to link a specific stressor with a specific disease have been unsuccessful. When the inflammatory response is critically involved in illnesses such as multiple sclerosis or lupus erythematosus, mood dysregulation and even depression are common.

In planning for a client's discharge, the nurse must know that the most serious risk for the client taking a tricyclic antidepressant is which of the following? A) Hypotension B) Narrow-angle glaucoma C) Seizures D) Suicide by overdose

Ans: D Feedback: Cyclic antidepressants (including tricyclic antidepressants) are potentially lethal if taken in an overdose. The cyclic antidepressants block cholinergic receptors, resulting in anticholinergic effects such as dry mouth, constipation, urinary hesitancy or retention, dry nasal passages, and blurred near vision. More severe anticholinergic effects such as agitation, delirium, and ileus may occur, particularly in older adults. Other common side effects include orthostatic hypotension, sedation, weight gain, and tachycardia. Clients may develop tolerance to anticholinergic effects (such as orthostatic hypotension and worsening of narrow-angle glaucoma, but these side effects are common reasons that clients discontinue drug therapy. The risk of seizures is increased by bupropion, which is a different type of antidepressant.

A woman has just had a therapeutic abortion to end an unintended pregnancy. Afterward, the woman cries because although she wanted to have children in future years, this pregnancy was not well-timed. Which type of grief is this woman most likely to experience? A) Anticipatory grief B) Absence of grief C) Complicated grief D) Disenfranchised grief

Ans: D Feedback: Disenfranchised grief is grief over a loss that is not or cannot be acknowledged openly, mourned, publicly, or supported socially. Anticipatory grief occurs when a person experiences imminent loss and begin to grapple with the very real possibility of loss or death in the near future. It is not absence of grief as the woman is grieving.

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

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

A nurse is teaching decision-making skills to a client with dependent personality disorder. According to Erikson, the likely cause of the client developing dependent personality is failure to meet the critical task of which developmental stage? A) Trust B) Autonomy C) Initiative D) Industry

Ans: D Feedback: Failure to complete the critical task results in a negative outcome for that stage of development and impedes completion of future tasks. Tasks of trust versus mistrust include viewing the world as safe and reliable and viewing relationships as nurturing, stable, and dependable. In autonomy versus shame and doubt, children achieve a sense of control and free will. In initiative versus guilt, the child begins to develop a conscience, and learns to manage conflict and anxiety. Industry versus inferiority involves school-age children

What is the major difference between posttraumatic stress disorder (PTSD) and acute stress disorder? A) In acute stress disorder, the client is likely to develop exacerbation of symptoms. B) In PTSD, the recovery rate is 80% within 3 months. C) The severity and duration of the trauma are the most important variables in acute stress disorder. D) In PTSD, the symptoms occur 3 months or more after the trauma.

Ans: D Feedback: In acute stress disorder, the symptoms occur 2 days to 4 weeks after a traumatic event and are resolved within 3 months of the event. In PTSD, the symptoms occur 3 months or more after the trauma. In PTSD, the client is likely to develop exacerbation of symptoms. The severity and duration of the trauma and the proximity of the person to the event are the most important factors affecting the likelihood of developing PTSD. In PTSD, complete recovery occurs within 3 months for about 50% of people

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

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

Which of the following client situations most urgently requires the nurse to break confidentiality and warn a third party? A) An abused woman states, ìI have dreams that he is dead.î B) A mother states, ìSometimes I feel like killing my kids!î C) A paranoid woman states, ìI'll get them before they get me.î D) A jealous man states, ìI am getting my gun and going to shoot my wife's lover!î

Ans: D Feedback: Mental health clinicians have a duty to warn identifiable third parties of threats made by clients, even if these threats were discussed during therapy sessions otherwise protected by privilege. The clinician must base his or her decision to warn others on the following: Is the client dangerous to others? Is the danger the result of serious mental illness? Is the danger serious? Are the means to carry out the threat available? Is the danger targeted at identifiable victims? Is the victim accessible?

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

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

The client says to the nurse, ìI know I can learn to cope with my family situation. By getting help here at the clinic, I'll be able to deal with them more effectively, and I won't be so stressed out all the time.î This client is demonstrating a high level of A) hardiness. B) resilience. C) sense of belonging. D) self-efficacy.

Ans: D Feedback: Self-efficacy is a belief that personal abilities and efforts affect the events in our lives. A person who believes that his or her behavior makes a difference is more likely to take action. Persons with high self-efficacy are self-motivated, get needed support, and cope effectively. Hardiness is the ability to resist illness when under stress. Resilience is defined as having healthy responses to stressful circumstances or risky situations. Sense of belonging is the client's place in the group, family, etc.

A client on the unit suddenly cries out in fear. The nurse notices that the client's head is twisted to one side, his back is arched, and his eyes have rolled back in their sockets. The client has recently begun drug therapy with haloperidol (Haldol). Based on this assessment, the first action of the nurse would be to A) get a stat. order for a serum drug level. B) hold the client's medication until the symptoms subside. C) place an urgent call to the client's physician. D) give a PRN dose of benztropine (Cogentin) IM.

Ans: D Feedback: The client is having an acute dystonic reaction; the treatment is anticholinergic medication. Dystonia is most likely to occur in the first week of treatment, in clients younger than 40 years, in males, and in those receiving high-potency drugs such as Haldol. Immediate treatment with anticholinergic drugs usually brings rapid relief.

A 22-year-old client has been manipulative of staff and disruptive in the milieu. Although she is not dangerous to herself or others, she has created problems on the unit and clearly is not making progress. The nurses offer prescribed medication, but she consistently refuses ìany drugs.î The staff realizes that legally this client can A) be coerced to accept treatment. B) be committed by her family to receive needed treatment. C) have her family sign permission for treatment. D) continue to refuse treatment.

Ans: D Feedback: The client maintains the right to refuse treatment even if it is needed when she is not dangerous to herself or others. If a client able to give consent, she cannot be coerced into doing so, have her family sign permission for her, or be committed by the family to receive treatment unless she is a danger to herself or others.

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

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

A client with severe and persistent mental illness has been taking antipsychotic medication for 20 years. The nurse observes that the client's behavior includes repetitive movements of the mouth and tongue, facial grimacing, and rocking back and forth. The nurse recognizes these behaviors as indicative of A) extrapyramidal side effects B) loss of voluntary muscle control C) posturing D) tardive dyskinesia

Ans: D Feedback: The client's behaviors are classic signs of tardive dyskinesia. Tardive dyskinesia, a syndrome of permanent involuntary movements, is most commonly caused by the longterm use of conventional antipsychotic drugs. Extrapyramidal side effects are reversible movement disorders induced by antipsychotic or neuroleptic medication. The client's behavior is not a loss of voluntary control or posturing

A patient with schizophrenia is being treated with olanzapine (Zyprexa) 10 mg. daily. The patient asks the nurse how this medicine works. The nurse explains that the mechanism by which the olanzapine controls the patient's psychotic symptoms is believed to be A) increasing the amount of serotonin and norepinephrine in the brain. B) decreasing the amount of an enzyme that breaks down neurotransmitters. C) normalizing the levels of serotonin, norepinephrine, and dopamine. D) blocking dopamine receptors in the brain.

Ans: D Feedback: The major action of all antipsychotics in the nervous system is to block receptors for the neurotransmitter dopamine. SSRIs and TCSs act by blocking the reuptake of serotonin and norepinephrine. MAOIs prevent the breakdown of MAO, an enzyme that breaks down neurotransmitters. Lithium normalizes the reuptake of certain neurotransmitters such as serotonin, norepinephrine, acetylcholine, and dopamine.

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

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

The nurse considers cultural variations pertaining to a client's nonverbal communication. Which of the following is the primary rationale for considering alternative meanings of nonverbal communication? A) The nurse must become expert at interpreting the client's gestures. B) Nonverbal signs indicative of certain mental illnesses transcend cultural differences. C) Mental illnesses impair a client's ability to express nonverbal messages. D) Nonverbal messages have different meanings in various cultures.

Ans: D Feedback: The nurse should be aware that nonverbal communication has different meanings in various cultures. These differences are important to note because many people make inferences about a person's behavior. The nurse can never know all culturally relevant messages. All communication is culturally relative. Persons with mental illness are fully capable of nonverbal expression.

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

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

The nurse is preparing a patient for an MRI scan of the head. The nurse should ask the patient, A) ìHave you ever had an allergic reaction to radioactive dye?î B) ìHave you had anything to eat in the last 24 hours?î C) ìDoes your insurance cover the cost of this scan?î D) ìAre you anxious about being in tight spaces?î

Ans: D Feedback: The person undergoing an MRI must lie in a small, closed chamber and remain motionless during the procedure, which takes about 45 minutes. Those who feel claustrophobic or have increased anxiety may require sedation before the procedure. PET scans require radioactive substances to be injected into the bloodstream. A patient is not required to fast before brain imaging studies. Verifying insurance benefits is not a primary role of the nurse.

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

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

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

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

When the nurse asks the client to restate the following in his or her own words, which sensorium and intellectual process is the nurse attempting to identify? The nurse states, ìA stitch in time saves nine.î A) The client's orientation B) The client's memory C) The client's ability to concentrate D) The client's ability to use abstract thin

Ans: D Feedback: When the nurse states, ìA stitch in time saves nine,î and asks the client to restate it in his or her own words, the nurse is assessing the client's ability to use abstract thinking. The client's orientation is recognizing person, place, and time. The client's memory, both recent and remote, can be assessed by asking the client questions that have verifiable answers. The client's ability to concentrate can be assessed by asking the client to perform certain tasks including spelling the word ìworldî backward.

The nurse is preparing to conduct an admission assessment interview with a Mexican American client. During the interview, the nurse should respect the client's culture through which behavior? A) Greet the client with a hug, B) Encourage direct eye contact during questioning C) Prohibiting the next of kin to remain present D) Introduce self with a handshake

Ans: D Feedback: With Mexican Americans touch by strangers is not appreciated, but a handshake is polite and welcomed. Nonverbal communication generally avoids direct eye contact with authority figures. Socially, contact with families comes fir

A female college student comes to the counseling center and tells the nurse she is afraid of her boyfriend. She states, ìHe is so jealous and overprotective; he wants to know where I am and who I'm with every minute.î Which of the following is most likely true of the situation? A) The student is overreacting. B) This is a situation requiring a restraining order. C) The student's boyfriend is simply insecure and needs reassurance. D) This is characteristic of the tension-building phase of the violence cycle

Feedback: In tension building, the abuser attempts to establish complete control over all the person's actions. It is more appropriate for the nurse to listen to the client, rather than to judge whether the client is overreacting. This may or may not require a restraining order. The student's boyfriend is insecure and needs reassurance, but that is not the only concern

Which of the following is most likely to prevent the client from experiencing complicated grief? A) Tendency to suppress emotions B) History of depression C) Places trusts familiar others D) Dependent on others to meet needs

Feedback: People who are vulnerable to complicated grieving include those with low self-esteem, low trust in others, a previous psychiatric disorder, previous suicide threats or attempts

A client with bipolar disorder has been taking lithium, and today his serum blood level is 2.0 mEq/L. What effects would the nurse expect to see? A) Constipation and postural hypotension B) Fever, muscle rigidity, and disorientation C) Nausea, diarrhea, and confusion D) None; the serum level is in therapeutic range

Feedback: Serum lithium levels of less than 0.5 mEq/L are rarely therapeutic, and levels of more than 1.5 mEq/L are usually considered toxic. The client would show signs of toxicity with a lithium level of 2.0 mEq/L. Toxic effects of lithium are severe diarrhea, vomiting, drowsiness, muscle weakness, and lack of coordination.

Which of the following statements about the crisis phase of aggression when the client becomes physically aggressive is true? A) All staff should act to take charge of the situation. B) The client must be restrained or sedated at once. C) Staff should avoid communicating with the client. D) Four to six trained staff members are needed to restrain.

ans D

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

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

Which of the following statements about anger, hostility and aggression are accurate? Select all that apply. A) Anger is an emotional response to a real or perceived provocation. B) Hostility stimulates the sympathetic nervous system. C) Physical aggression involves harming other persons or property. D) Anger, hostility, and physical aggression are normal human emotions. E) Hostility is also referred to as verbal aggression. F) Physical aggression often progresses to hostility

ans: A,C,E

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

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

A client reports feeling like he belongs among his peers with whom he shares a group home. The nurse incorporates this sense of belonging when formulating discharge plans because the nurse understands which of the following? A) Living with a peer group often increases anxiety. B) Peers may alienate the client from daily living activities. C) The client will likely feel needed by his peers. D) Peer groups often do too much for each other causing dependency.

ns: C Feedback: An increased sense of belonging is associated with decreased levels of anxiety. Persons with a sense of belonging are less alienated and isolated, have a sense of purpose, believe they are needed by others, and feel productive socially.