Chapter 12. Milieu Therapy—The Therapeutic Community, Chapter 15. Promoting Self-Esteem, Chapter 11. Intervention With Families, Chapter 10. Therapeutic Groups, Chapter 4. Concepts of Psychobiology, Chapter 7. Relationship Development, Chapter 20. El...

A nurse is planning care for the termination phase of a nurse-client relationship. Which of the following actions is appropriate to include in the plan of care? A. Discussing ways to use new behaviors B. Practicing new problem-solving skills C. Developing goals D. Establishing boundaries

A

What is the goal of assertive behavior? a. To communicate effectively and to be respected by others b. Agreeing assertively

To communicate effectively and to be respected by others

A client voluntarily assists another client in the anger management group by sharing experiences about controlling anger. Which curative factor does the client exhibit? 1. Altruism 2. Development of socializing techniques 3. Universality 4. Imitative behavior

1. Altruism

Which symptoms are observed in a client with high anxiety levels? Select All That Apply. 1. Obsessive thoughts 2. Overwhelming feelings 3. Increase in functionality 4. Behavior aimed at relief of anxiety 5. Belief in presence of problem-solving resources

1. Obsessive thoughts 2. Overwhelming feelings 4. Behavior aimed at relief of anxiety

After losing a friend in a motorcycle accident, the client tells the nurse, "I should have died in the accident instead of my friend because I was driving the bike too fast." What does the client's statement indicate? 1. Survivor's guilt 2. Spiritual distress 3. Suicidal ideation 4. Withdrawn behavior

1. Survivor's guilt

How should the nurse promote a client's connection with community life during milieu therapy? Select all that apply. 1. Encouraging the client to share meals with family members 2. Allowing the client to attend movies with peer groups 3. Encouraging the client to visit a nearby zoo 4. Allowing the client to participate in shopping activities 5. Involving the client in the decision-making and problem-solving pro

2. Allowing the client to attend movies with peer groups 3. Encouraging the client to visit a nearby zoo 4. Allowing the client to participate in shopping activities

A client who lost her husband in an accident says, "It hurts whenever I remember the time spent with my husband." Which nursing intervention should the nurse perform to calm the client? 1. Determine the presence of conflicts. 2. Encourage the client to meditate. 3. Listen to the client's expressions of an inability to find meaning in life. 4. Assist the client in developing goals to deal with the present situation.

2. Encourage the client to meditate.

Which credentials are required to become a psychodramatist? Select all that apply. 1. License to practice medicine 2. Graduate degree in psychology 3. Graduate degree in social work 4. Additional training in group therapy 5. College degree with advanced education in seminary

2. Graduate degree in psychology 3. Graduate degree in social work 4. Additional training in group therapy

Which interdisciplinary treatment team member focuses on one-to-one relationship development with the client? 1. Psychodramatist 2. Psychiatric nurse 3. Recreational therapist 4. Psychiatric clinical nurse specialist

2. Psychiatric nurse

Which health-care professional is responsible in an interdisciplinary team to ascertain that the client's physiological needs are met? 1. Psychiatrist 2. Psychodramatist 3. Psychiatric nurse 4. Clinical psychologist

2. Psychodramatist

According to Roberts' seven-stage crisis intervention model, what is the primary intervention during Stage IV? 1. Identifying major problems 2. Implementing an action plan 3. Dealing with feelings and emotions 4. Generating and exploring alternatives

3. Dealing with feelings and emotions

What aspect is directly manipulated in the treatment when using milieu therapy? 1. Behavior of the client 2. Functioning of the client 3. Environment around the client 4. Psychological health of the client

3. Environment around the client

What information is required to prepare an interdisciplinary treatment (IDT) plan for a client with a psychotic disorder in therapeutic milieu? 1. Information about the medical diagnosis 2. Information about cultural and spiritual needs 3. Information from the initial nursing assessment 4. Information from community and family resources

3. Information from the initial nursing assessment

The nurse is caring for a client with spiritual distress. Which nursing action will help identify the need for further intervention to prevent a suicide attempt in the client? 1. Using therapeutic communication 2. Encouraging the client to practice meditation and prayer 3. Listening to the client's expression of the inability to find meaning in life 4. Making time for nonjudgmental discussion of philosophical issues

3. Listening to the client's expression of the inability to find meaning in life

Question 6. Which intervention does the therapist adopt to facilitate interpersonal communication? 1. Setting norms and rules for the client 2. Assigning responsibilities to the client 3. Maintaining a structured schedule of social activities 4. Including the family and the community of the client in therapy

3. Maintaining a structured schedule of social activities

A 2-year-old child witnessed a tragic accident. Which psychological symptoms would the nurse observe in this child? Select all that apply. 1. Fear 2. Arousal 3. Nightmares 4. Separation anxiety 5. Regressive behaviors

3. Nightmares 4. Separation anxiety 5. Regressive behaviors

The nurse, who is caring for a client undergoing a crisis, says, "Try to consider your problem from a different perspective." Which phase of crisis development is the client undergoing right now? 1. Phase 1 2. Phase 2 3. Phase 3 4. Phase 4

3. Phase 3

Which type of therapeutic group involves the rotation of leadership from one person to another? 1. Task group 2. Teaching group 3. Self-help group 4. Supportive group

3. Self-help group

Question 5. The nurse is caring for a client who is receiving occupational therapy. Which outcome in the client is most likely to indicate effective therapy? 1. The client shows a decrease in anger issues. 2. The client has a decreased level of anxiety. 3. The client has fewer self-esteem problems. 4. The client has demonstrates reduced passive-aggression.

3. The client has fewer self-esteem problems.

While communicating to a client with spiritual distress, the nurse says, "I would like to discuss philosophical issues with you." Which outcome does the nurse expect in the client through this interaction? 1. The client will be able to resolve feelings about the disaster. 2. The client will find his or her own solutions to concerns. 3. The client will begin to look at the basis for spiritual confusion. 4. The client will show a reduction in impediments to the grief process.

3. The client will begin to look at the basis for spiritual confusion

While caring for a client with acute stress disorder, the therapist uses recreational activities as a part of the therapy. Which outcome in the client will indicate effectiveness of the therapy? 1. The client will show interpersonal interactions. 2. The client will resolve underlying conflicts. 3. The client will learn skills that can be used in leisure time. 4. The client will show independence in performing activities of daily life.

3. The client will learn skills that can be used in leisure time.

Why will the nurse recommend that a client with posttrauma syndrome participate in debriefing sessions? 1. To promote self-control in the client 2. To strengthen the client's ability to cope 3. To facilitate recovery of the client from the traumatic event 4. To specify the need for more intensive therapy

3. To facilitate recovery of the client from the traumatic event

Which client's statement indicates spiritual distress? 1. "I should have also died in that accident." 2. "I get involved in a lot of fights with my neighbors." 3. "Swine flu has spread all around the world and I am afraid that I am going to get it." 4. "God is angry with humanity. I am sure that the world will soon end."

4. "God is angry with humanity. I am sure that the world will soon end."

A client's house was destroyed in a tornado. The client received minor injuries but experiences anxiety every time a storm approaches. Which type of crisis does the client have? 1. Dispositional crisis 2. Maturational/developmental crisis 3. Crisis of anticipated life transitions 4. Crisis resulting from traumatic stress

4. Crisis resulting from traumatic stress

While caring for a client who has low self-esteem, the nurse observes an improvement in the client's present condition due to the functional activities of a group to which the client belongs. Which function of a group can bring change in the client? 1. Camaraderie 2. Normative 3. Socialization 4. Empowerment

4. Empowerment

A disagreement between the nurse and a member of the group results in a conflict within a group. Which member of the group minimizes the tension by intervening? 1. Encourager 2. Follower 3. Gatekeeper 4. Harmonizer

4. Harmonizer

An individual with a graduate degree in social work and additional training in group therapy visits the human resources department of a hospital. Which role could the individual play in the health-care team? 1. Psychodramatist 2. Psychiatric nurse 3. Mental health technician 4. Psychiatric social worker

4. Psychiatric social worker

During an assertiveness training group, a nurse suggests using "I statements." The group questions the usefulness of this communication technique. Which explanation by the nurse is most appropriate? A. "When 'I statements' are used, opinions are communicated without blaming others." B. "When 'I statements' are used, anger is displaced by using indirect means." C. "When 'I statements' are used, responsibility for one's behavior is attributed to another." D. "When 'I statements' are used, eye contact is promoted."

ANS: A "I statements" clearly state one's feelings and needs without blaming or demeaning others. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

When scheduling electroconvulsive therapy (ECT), which client should the nurse prioritize? A. A client in bed in a fetal position who is experiencing active suicidal ideations B. A client with an irritable mood and exhibiting angry outbursts C. A client experiencing command hallucinations and delusions of reference D. A client experiencing manic episodes of bipolar disorder

ANS: A A client who is experiencing suicidal ideations is in need of an immediate intervention to prevent self-harm and must be prioritized when the nurse schedules ECT. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment

A client scheduled for electroconvulsive therapy (ECT) at 9:00 a.m. is discovered eating breakfast at 8:00 a.m. On the basis of this observation, which is the most appropriate nursing action? A. The nurse notifies the client's physician of the situation and cancels the ECT. B. The nurse removes the breakfast tray and assists the client to the ECT procedure room. C. The nurse allows the client to finish breakfast and reschedules ECT for 10:00 a.m. D. The nurse increases the client's fluid intake to facilitate the digestive process.

ANS: A A client who is scheduled for ECT procedures is given nothing by mouth (NPO) for a minimum of 6 to 8 hours before treatment. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Physiological Integrity: Reduction of Risk Potential

A nurse should recognize which intervention as most appropriate within a behavioral therapy program? A. A child is given a Popsicle for staying dry and clean. B. A child is put in time-out after soiling his or her undergarments. C. A child is allowed to remain in soiled undergarments. D. A child is taught the advantages of staying dry and clean.

ANS: A A stimulus that follows a behavior or response is called a reinforcing stimulus or reinforcer. The reward of a Popsicle is a reinforcer for the child staying dry and clean. This is an example of operant conditioning, a form of behavioral therapy. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

According to Peplau, which nursing intervention is most appropriate when the nurse is functioning in the role of a surrogate? A. The nurse functions as a nurturing parent in order to build a trusting relationship. B. The nurse plays cards with a small group of clients. C. The nurse discusses childhood events that may affect personality development. D. The nurse provides a safe social environment.

ANS: A According to Peplau, when a client is acutely ill, he or she may incur the role of infant or child, while the nurse is perceived as the mother surrogate. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

Two clients are roommates on an inpatient psychiatric unit. At breakfast, client "A," who had been missing her gold locket, notices client "B" wearing it. Which should a nurse recognize as a nonassertive or passive behavioral response from client "A"? A. Client "A" ignores the situation. B. Client "A" discusses the situation with her nurse and develops a plan of action. C. Client "A" immediately approaches client "B" and pulls the necklace off her neck. D. Client "A" offers to wash client "B's" clothes and "accidentally" spills bleach in the water.

ANS: A By ignoring the situation, client "A" avoids conflict, denies her feelings, and does not assertively resolve the problem. This is an example of nonassertive behavior. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A nurse is caring for a client who has threatened to commit suicide by hanging. The client states, "I'm going to use a knotted shower curtain when no one is around." Which information would determine the nurse's plan of care for this client? A. The more specific the plan is, the more likely the client will attempt suicide. B. Clients who talk about suicide never actually commit it. C. Clients who threaten suicide should be observed every 15 minutes. D. After a brief assessment, the nurse should avoid the topic of suicide.

ANS: A Clients who have specific plans are at greater risk for suicide. KEY: Cognitive Level: Application | Integrated Processes: Assessment | Client Need: Safe and Effective Care Environment

Two clients get into a heated argument regarding TV program selections. The nurse turns off the TV and asks the clients to go to their rooms to cool off, after which they will discuss and attempt to resolve the problem. The nurse's action is promoting which assertive technique? A. Defusing B. Clouding or fogging C. Responding as a broken record D. Shifting from content to process

ANS: A Defusing is a technique that delays further discussion with an angry individual until a calm demeanor has been achieved. In the situation presented, the nurse is allowing the clients to calm down prior to addressing their issues. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A chronically depressed and suicidal client is admitted to a psychiatric unit. The client is scheduled for electroconvulsive therapy (ECT). During the course of ECT, a nurse should recognize the continued need for which critical intervention? A. Suicide assessment must continue throughout the ECT course. B. Antidepressant medications are contraindicated throughout the ECT course. C. Discourage expressions of hopelessness throughout the ECT course. D. Encourage a high-caloric diet throughout the ECT course.

ANS: A ECT is an intervention for major depression that often includes suicidal ideations as a symptom. Continued suicide assessment is needed because mood improvement due to ECT may cause the client to act on suicidal ideations. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment

Which is a nursing intervention to assist a client to achieve Erikson's developmental task of ego integrity? A. Encourage a life review of triumphs and disappointments. B. Provide opportunities for success experiences. C. Focus on embracing the future. D. Foster the development of creativity.

ANS: A Erikson believed that between the age of 65 years and death, the goal is to review one's life and derive meaning from both positive and negative events, while achieving a positive sense of self. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

Immediately after an initial electroconvulsive therapy (ECT) procedure, a client states, "I'm not hungry and just want to stay in bed and sleep." On the basis of this information, which is the most appropriate nursing intervention? A. Allow the client to remain in bed. B. Encourage the client to join the milieu to promote socialization. C. Obtain a physician's order for parenteral nutrition. D. Involve the client in physical activities to stimulate circulation.

ANS: A Immediately after electroconvulsive therapy a nurse should monitor pulse, respirations, and blood pressure every 15 minutes for the first hour, during which time the client should remain in bed. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment

When an individual's stress response is sustained over a long period of time, which physiological effect of the endocrine system should a nurse anticipate? A. Decreased resistance to disease B. Increased libido C. Decreased blood pressure D. Increased inflammatory response

ANS: A In a general adaptation syndrome, prolonged exposure to stress leads to the stage of exhaustion at which time the body's compensatory mechanisms no longer function effectively and diseases of adaptation occur. A decreased immune response is seen at this stage. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Physiological Integrity

A third-grader feigns illness in order to avoid doing homework. The teacher recommends an educational program that uses a token economy. How should a school nurse explain a token economy to this child's parent? A. "Your child will receive green tokens for completing homework that can be cashed in for desired rewards." B. "Your child will receive red tokens when homework is incomplete and this will result in school suspension." C. "Your child will receive a time out for each homework assignment not completed." D. "Your child, with your assistance, will envision receiving rewards for completed homework."

ANS: A In a token economy, tokens are a form of contingency contracting in that tokens immediately reinforce appropriate behavior (completed homework) and are exchanged later for a desired reward. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A mother states, "You are old enough to clean your own bedroom." Later inspection finds the floor clear, but with everything stacked in a chair. The mother praises the child for clearing the floor. This is consistent with which technique of behavior modification? A. Shaping B. Extinction C. Stimulus generalization D. Reciprocal inhibition

ANS: A In shaping, behavior is molded in a desired direction by reinforcing each small step toward the desired behavior. The child is praised for clearing the floor, the first step toward cleaning the room. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

A client has been brought to the emergency department for signs and symptoms of Chronic Obstructive Pulmonary Disease (COPD). The client has a history of a suicide attempt 1 year ago. Which nursing intervention would take priority in this situation? A. Assessing the client's pulse oximetry and vital signs B. Developing a plan for safety for the client C. Assessing the client for suicidal ideations D. Establishing a trusting nurse-client relationship

ANS: A It is important to prioritize client interventions that assess the symptoms of COPD prior to any other nursing intervention. Physical needs must be prioritized according to Maslow's hierarchy of needs. This client's problems with oxygenation will take priority over assessing for current suicidal ideations. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Safe and Effective Care Environment

Meditation has been shown to be an effective stress management technique. When meditation is effective, what should a nurse expect to assess? A. An achieved state of relaxation B. An achieved insight into one's feelings C. A demonstration of appropriate role behaviors D. An enhanced ability to problem-solve

ANS: A Meditation produces relaxation by creating a special state of consciousness through focused concentration. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

According to Peplau, treatment of client symptoms should involve which nursing action? A. Establishing a therapeutic nurse-client relationship B. Using the technique of desensitization C. Challenging clients' negative thoughts D. Uncovering clients' past experiences

ANS: A Peplau applied interpersonal theory to nursing practice and, most specifically, to nurse-client relationship development. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

Which client statement should alert a nurse that a client may be responding maladaptively to stress? A. "I've found that avoiding contact with others helps me cope." B. "I really enjoy journaling; it's my private time." C. "I signed up for a yoga class this week." D. "I made an appointment to meet with a therapist."

ANS: A Reliance on social isolation as a coping mechanism is a maladaptive method to relieve stress. It can prevent learning appropriate coping skills and can prevent access to needed support systems. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

Which statement describes achievement of Erikson's generativity versus stagnation developmental stage? A. "I've been a girl scout leader for troop 259 for 7 years." B. "I feel great that I could pay for my bike with my paper route money." C. "My parents are so pleased that John and I are going to be married." D. "I've had a very full life. I'm not afraid to leave this world."

ANS: A The major task of generativity versus stagnation is to achieve the life goals established for oneself while also considering the welfare of future generations. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

Which underlying concept should a nurse associate with interpersonal theory when assessing clients? A. The effects of social processes on personality development B. The effects of unconscious processes and personality structures C. The effects on thoughts and perceptual processes D. The effects of chemical and genetic influences

ANS: A The nurse should associate interpersonal theory with the underlying concept of effects of social process on personality development. Sullivan developed stages of personality development based on his theory of interpersonal relationships and their effect on personality and individual behavior. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

If clozapine (Clozaril) therapy is being considered, which laboratory test should a nurse review to establish a baseline for comparison to evaluate a potentially life-threatening side effect? A. While blood cell count B. Liver function studies C. Creatinine clearance D. Blood urea nitrogen

ANS: A The nurse should establish a baseline white blood cell count to evaluate a potentially life-threatening side effect if clozapine (Clozaril) is being considering as a treatment option. Clozapine (Clozaril) can have a serious side effect of agranulocytosis, in which a potentially fatal drop in white blood cells can occur. PTS: 1 REF: Page: 345 KEY: Cognitive Level: Knowledge | Integrated Process: Nursing Process: Assessment

After taking chlorpromazine (Thorazine) for 1 month, a client presents to an emergency department (ED) with severe muscle rigidity, tachycardia, and a temperature of 105oF (40.5?C). Which medical diagnosis and treatment should a nurse anticipate when planning care for this client? A. Neuroleptic malignant syndrome treated by discontinuing Thorazine and administering dantrolene (Dantrium). B. Neuroleptic malignant syndrome treated by increasing Thorazine dosage and administering an antianxiety medication. C. Dystonia treated by administering trihexyphenidyl (Artane). D. Dystonia treated by administering bromocriptine (Parlodel).

ANS: A The nurse should expect that an ED physician would diagnose the client with neuroleptic malignant syndrome and treat the client by discontinuing chlorpromazine (Thorazine) and administering dantrolene (Dantrium). Neuroleptic malignant syndrome is a potentially fatal condition characterized by rigidity, fever, altered consciousness, and autonomic instability. The use of typical antipsychotics is largely being replaced by atypical antipsychotics due to fewer side effects and lower risk. PTS: 1 REF: Page: 346 KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Planning

Which client response should a nurse expect during the working phase of the nurse-client relationship? A. The client gains insight and incorporates alternative behaviors. B. The client and nurse establish rapport and mutually develop treatment goals. C. The client explores feelings related to reentering the community. D. The client explores personal strengths and weaknesses that impact behaviors.

ANS: A The nurse should expect that the client would gain insight and incorporate alternative behaviors during the working phase of the nurse-client relationship. The client may also overcome resistance, problem-solve, and continually evaluate progress toward goals. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A 16-year-old-client diagnosed with paranoid schizophrenia experiences command hallucinations to harm others. The client's parents ask a nurse, "Where do the voices come from?" Which is the appropriate nursing response? A. "Your child has a chemical imbalance of the brain, which leads to altered thoughts." B. "Your child's hallucinations are caused by medication interactions." C. "Your child has too little serotonin in the brain, causing delusions and hallucinations." D. "Your child's abnormal hormonal changes have precipitated auditory hallucinations."

ANS: A The nurse should explain that a chemical imbalance of the brain leads to altered thought processes. Hallucinations, or false sensory perceptions, may occur in all five senses. The client hearing voices is experiencing an auditory hallucination

A female complains that her husband only meets his sexual needs and never her needs. According to Freud, which personality structure should a nurse identify as predominantly driving the husband's actions? A. The id B. The superid C. The ego D. The superego

ANS: A The nurse should identify that the husband's actions are driven by the predominance of the id. According to Freud, the id is the part of the personality that is identified as the pleasure principle. The id is the locus of instinctual drives. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Analysis | Client Need: Psychosocial Integrity

A client diagnosed with schizophrenia is prescribed clozapine (Clozaril). Which client symptoms, related to the side effects of this medication, should prompt a nurse to intervene immediately? A. Sore throat, fever, and malaise B. Akathisia and hypersalivation C. Akinesia and insomnia D. Dry mouth and urinary retention

ANS: A The nurse should intervene immediately if the client experiences a sore throat, fever, and malaise when taking the atypical antipsychotic drug clozapine (Clozaril). Clozapine (Clozaril) can have a serious side effect of agranulocytosis, in which a potentially fatal drop in white blood cells can occur. PTS: 1 REF: Pages: 345-346 KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Implementation

Immediately after electroconvulsive therapy, in which position should a nurse place the client? A. On his or her side to prevent aspiration B. In semi-Fowler's position to promote oxygenation C. In Trendelenburg's position to promote blood flow to vital organs D. In prone position to prevent airway blockage

ANS: A The nurse should place a client who has received electroconvulsive therapy on his or her side to prevent aspiration. After the treatment, most clients will awaken within 10 to 15 minutes and will be confused and disoriented. Some clients will sleep for 1 to 2 hours. All clients require close observation following treatment. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Physiological Integrity

A 10-year-old child wins the science fair competition and is chosen as a cheerleader for the basketball team. A nurse should recognize that this child is in the process of successfully accomplishing which stage of Erikson's developmental theory? A. Industry versus inferiority B. Identity versus role confusion C. Intimacy versus isolation D. Generativity versus stagnation

ANS: A The nurse should recognize that a 10-year-old child who is successful in school both academically and socially has successfully accomplished the industry versus inferiority developmental stage of Erikson's psychosocial theory. The industry versus inferiority stage of development usually occurs between 6 and 12 years of age, at which time individuals achieve a sense of self-confidence by learning, competing, performing successfully, and receiving recognition from others. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

Which statement should indicate to a nurse that an individual is experiencing a delusion? A. "There's an alien growing in my liver." B. "I see my dead husband everywhere I go." C. "The IRS may audit my taxes." D. "I'm not going to eat my food. It smells like brimstone."

ANS: A The nurse should recognize that a client who claims that an alien is inside the body is experiencing a delusion. Delusions are false personal beliefs that are inconsistent with the person's intelligence or cultural background. PTS: 1 REF: Page: 318 KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Analysis

A client has made the decision to leave her alcoholic husband. She is feeling very depressed. Which nontherapeutic statement by the nurse conveys sympathy? A. "You are feeling very depressed. I felt the same way when I decided to leave my husband." B. "I can understand you are feeling depressed. It was a difficult decision. I'll sit with you." C. "You seem depressed. It was a difficult decision to make. Would you like to talk about it?" D. "I know this is a difficult time for you. Would you like a prn medication for anxiety?"

ANS: A The nurse's statement, "You are feeling very depressed. I felt the same when I decided to leave my husband," is a nontherapeutic statement that conveys sympathy. Sympathy implies that the nurse shares what the client is feeling and by this personal expression alleviates the client's distress. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

Which nursing intervention strategy is most appropriate to implement initially with a suicidal client? A. Ask a direct question such as, "Do you ever think about killing yourself?" B. Ask client, "Please rate your mood on a scale from 1 to 10." C. Establish a trusting nurse-client relationship. D. Apply the nursing process to the planning of client care.

ANS: A The risk of suicide is greatly increased if the client has suicidal ideations, if the client has developed a plan, and particularly if the means exist for the client to execute the plan. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment

One nurse confronts another and says, "You are always so talkative in the meetings. I don't know why you can't stay quiet sometimes." Which reply by the other nurse reflects the technique of "clouding/fogging?" A. "You're right. I do speak up a lot." B. "Sounds to me like you're agitated and we need to talk. What are you truly angry about?" C. "Are you offended that I speak up, or because my thoughts are in opposition to yours?" D. "I have the right to express my opinion."

ANS: A This response reflects the use of clouding/fogging. When clouding/fogging is used it concurs with the critic's argument without becoming defensive and without agreeing to change. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

Which client statement may indicate a transference reaction? A. "I need a real nurse. You are young enough to be my daughter and I don't want to tell you about my personal life." B. "I deserve more than I am getting here. Do you know who I am and what I do? Let me talk to your supervisor." C. "I don't seem to be able to relate to people. I would rather stay in my room and be by myself." D. "My mother is the source of my problems. She has always told me what to do and what to say."

ANS: A Transference occurs when a client unconsciously displaces or "transfers" to the nurse feelings formed toward a person from the past. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A client begins to smash furniture, cannot be "talked down," and refuses medications. Which is the most appropriate nursing intervention? A. Call a violence code. B. Ask the ward clerk to put in a call for the physician. C. Place the client in seclusion. D. Place the client in four-point restraints.

ANS: A In this situation the nurse must have adequate, trained help to prevent injury to the client or staff. Calling a violence code will access this help. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment

Which of the following are behavioral components of assertive communication? A. Listening B. "You" statements C. Closed posture D. Continuous direct eye contact

ANS: A One part of assertiveness communication and behavior is to listen and take time to understand what is being said before giving a response. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

Which client statement demonstrates improvement in anger/aggression management? A. "I realize I have a problem expressing my anger appropriately." B. "I know I can't use physical force anymore, but I can intimidate someone with my words." C. "It's bad to feel as angry as I feel. I'm working on eliminating this poisonous emotion entirely." D. "Because my wife seems to be the one to set me off, I've decided to remain separated from her."

ANS: A The client is recognizing and taking responsibility for personal anger. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

Which of the following symptoms should a nurse associate with increased levels of thyroid-stimulating hormone (TSH) in a newly admitted client? Select all that apply. A. Depression B. Fatigue C. Increased libido D. Mania E. Hyperexcitability

ANS: A, B The nurse should associate depression and fatigue with increased levels of TSH. TSH is only increased when thyroid levels are low, as in the diagnosis of hypothyroidism. In addition to depression and fatigue, other symptoms such as decreased libido, memory impairment, and suicidal ideation are also associated with chronic hypothyroidism. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Analysis | Client Need: Physiological Integrity

A nurse should recognize that electroconvulsive therapy (ECT) would potentially improve the symptoms of clients with which of the following diagnoses? Select all that apply. A. Major depressive disorder B. Bipolar I disorder: manic episode C. Schizoaffective disorder D. Obsessive-compulsive disorder E. Body dysmorphic disorder

ANS: A, B, C ECT has been shown to be effective in the treatment of severe depression, acute mania, and acute schizophrenia, particularly if it is accompanied by catatonic or affective (depression or mania) symptomatology. ECT has also been tried with other disorders, such as obsessive-compulsive disorder (OCD) and anxiety disorders, but little evidence exists to support its efficacy in the treatment of these conditions. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Safe and Effective Care Environment

After a teenager reveals that he is gay, the father responds by beating him. The next morning, the teenager is found hanging in his closet. Which paternal grief responses should a nurse anticipate? Select all that apply. A. "I can't believe this is happening." B. "If only I had been more understanding." C. "How dare he do this to me!" D. "I'm just going to have to accept that he was gay." E. "Well, that was a selfish thing to do."

ANS: A, B, C Suicide of a family member can induce a whole gamut of feelings in the survivors. Shock, disbelief, guilt, remorse, anger, and resentment are all feelings that may be experienced by this father. The last two possible responses suggest acceptance and understanding. It is far more common for survivors of suicide to have a sense of feeling wounded and as if they will never get over it. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

Laboratory results reveal decreased levels of prolactin in a client diagnosed with schizophrenia. Which client symptoms should a nurse expect to observe during assessment?(Select all that apply.) A. Apathy B. Social withdrawal C. Anhedonia. D. Auditory hallucinations E. Delusions

ANS: A, B, C The nurse should expect that a client with decreased levels of prolactin would experience apathy, social withdrawal, and anhedonia. Decreased levels of prolactin can cause depression, which would result in the above symptoms. PTS: 1 REF: Page: 343 KEY: Cognitive Level: Comprehension | Integrated Process: Nursing Process: Assessment

A nurse is caring for four clients. Which of the following clients should the nurse identify as likely to experience difficulty in being assertive? Select all that apply. A. A 20-year-old woman who is completing college homework assignments for several peers. B. A 69-year-old widow who is socially isolated C. A 17-year-old boy with conduct disorder D. A 45-year-old successful executive E. A 50-year-old diagnosed with narcissistic personality disorder

ANS: A, B, C The woman who is taking on the work of others in addition to her own may be having difficulty assertively saying "no"; the widow who is socially isolated may lack the necessary skills to communicate her needs; and the boy with a conduct disorder is likely to demonstrate aggressive behaviors. The business executive and an individual diagnosed with narcissistic personality disorder are the least likely to have difficulty being assertive. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

During a course of 12 electroconvulsive therapy (ECT) procedures, an anxious client diagnosed with major depression refuses to bathe or attend group therapy. He reports some memory problems and says he has trouble figuring out what time of day it is. At this time, which of the following nursing diagnoses should be assigned to this client? Select all that apply. A. Anxiety R/T post-ECT confusion and memory loss B. Risk for injury R/T post-ECT confusion and memory loss C. Risk for activity intolerance R/T post-ECT confusion and memory loss D. Altered sensory perception R/T post-ECT confusion and memory loss E. Social isolation R/T post-ECT confusion and memory loss

ANS: A, B, C, E Because of the post-ECT thought alterations of confusion and memory loss, the client is anxious, is accident prone, and has socially isolated self. Altered sensory perception is related to psychotic thoughts of a sensory nature such as hallucinations, and because this client is diagnosed with major depression, not schizophrenia, altered sensory perception would not be anticipated. KEY: Cognitive Level: Analysis | Integrated Process: Nursing Process: Analysis | Client Need: Psychosocial Integrity

A nurse is working with a client who has recently been under a great deal of stress. Which nursing recommendations would be most helpful when assisting the client in coping with stress? Select all that apply. A. "Enjoy a pet." B. "Spend time with a loved one." C. "Listen to music." D. "Focus on the stressors." E. "Journal your feelings."

ANS: A, B, C, E Focusing on the stressors is more likely to increase stress in the client's life. However, pets, music, journaling feelings, and healthy relationships have all been shown to decrease amounts of stress. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

Which concepts are included in the definition of personality? Select all that apply. A. Personality is the characteristic way in which a person thinks, feels, and behaves. B. Personality is the ingrained pattern of behavior that evolves as one's style of life. C. Personality is developed in sporadic stages that vary from person to person. D. Personality develops both consciously and unconsciously. E. Personality is inborn and cannot be influenced by developmental progression.

ANS: A, B, D Black and Andreasen (2011) offer a definition of personality that includes each of the concepts in answers A, B, and D. Various theorists have identified stages in the development of personality; none identify personality development as sporadic or variable. KEY: Cognitive Level: Analysis| Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

Which of the following conditions would place a client at risk for injury during electroconvulsive therapy (ECT)? Select all that apply. A. Severe osteoporosis B. Acute and chronic pulmonary disorders C. Hypothyroidism D. Recent cardiovascular accident E. Prostatic hypertrophy

ANS: A, B, D Severe osteoporosis, acute and chronic pulmonary disorders, and a recent history of cardiovascular accident (CVA) can render clients at high risk for injury during electroconvulsive therapy. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Assessment | Client Need: Physiological Integrity: Reduction of Risk Potential

Which assessment results should a nurse evaluate and report in the process of clearing a client for electroconvulsive therapy (ECT)? Select all that apply. A. Electrocardiographic records B. Pulmonary function study results C. Electroencephalogram analysis D. Complete blood count values E. Urinalysis results

ANS: A, B, D, E A nurse should evaluate electrocardiographic records, pulmonary function study results, complete blood count, and urinalysis results and report any abnormalities to the client's physician. The client must be medically cleared prior to ECT. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Safe and Effective Care Environment

Which components should a nurse recognize as an integral part of a rehabilitative program when planning care for clients diagnosed with schizophrenia? (Select all that apply.) A. Group therapy B. Medication management C. Deterrent therapy D. Supportive family therapy E. Social skills training

ANS: A, B, D, E The nurse should recognize that group therapy, medication management, supportive family therapy, and social skills training all play an integral part of rehabilitative programs for clients diagnosed with schizophrenia. Schizophrenia results from various combinations of genetic predispositions, biochemical dysfunctions, physiological factors, and psychological stress. Effective treatment requires a comprehensive, multidisciplinary effort. PTS: 1 REF: Pages: 338-340 KEY: Cognitive Level: Comprehension | Integrated Process: Nursing Process: Planning

A nurse is interviewing a distressed client, who relates being fired after 15 years of loyal employment. Which of the following questions would best assist the nurse to determine the client's appraisal of the situation? Select all that apply. A. "What resources have you used previously in stressful situations?" B. "Have you ever experienced a similar stressful situation?" C. "Who do you think is to blame for this situation?" D. "Why do you think you were fired from your job?" E. "What skills do you possess that might lead to gainful employment?"

ANS: A, B, E These questions specifically address the client's coping resources and encourage the client to apply learning from past experiences. These questions also encourage the client to consider alternative methods for dealing with stress. Asking who is to blame does not assess coping abilities but, rather, encourages maladaptive behavior. Requesting an explanation is a nontherapeutic block to communication. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A nursing student is developing a study guide related to historical facts about suicide. Which of the following facts should the student include? Select all that apply. A. In the Middle Ages, suicide was viewed as a selfish and criminal act. B. During the Roman Empire, suicide was followed by incineration of the body. C. Suicide was an offense in ancient Greece, and a common-site burial was denied. D. During the Renaissance, suicide was discussed and viewed more philosophically. E. Old Norse traditionally set a person who committed suicide adrift in the North Sea.

ANS: A, C, D These are true historical facts about suicide and should be included in the student's study guide. KEY: Cognitive Level: Application | Integrated Processes: Teaching/Learning | Client Need: Psychosocial Integrity

A nurse is administering risperidone (Risperdal) to a client diagnosed with schizophrenia. Which symptoms should a nurse expect the therapeutic effect of this medication to address? (Select all that apply.) A. Somatic delusions B. Social isolation C. Gustatory hallucinations D. Flat affect E. Clang associations

ANS: A, C, E The nurse should expect that risperidone (Risperdal) would be effective treatment for somatic delusions, gustatory hallucinations, and clang associations. Risperidone (Risperdal) is an atypical antipsychotic that has been effective in the treatment of schizophrenia and in maintenance therapy to prevent exacerbation of schizophrenic symptoms. PTS: 1 REF: Page: 337 KEY: Cognitive Level: Comprehension | Integrated Process: Nursing Process: Implementation

A nurse notices a client clenching fists periodically and pacing the hallway. Which of the following nursing interventions would best assist the client at this time? Select all that apply. A. Acknowledge the client's behavior. B. Initiate forced medication protocol.C. Assist the client to a quiet area. D. Initiate confinement measures. E. Speak with a soft and calming voice.

ANS: A, C, E The nurse should remain calm when dealing with an angry client. It is important to acknowledge the client's behavior and assist the client to a less stimulating environment. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A nurse is conducting education on anxiety and stress management. Which of the following should be identified as the most important initial step in learning how to manage anxiety? A. Diagnostic blood tests B. Awareness of factors creating stress C. Relaxation exercises D. Identifying support systems

ANS: B Although all of the above answers may be useful in the comprehensive management of stress, the initial step is awareness that stress is being experienced and awareness of factors that create stress. KEY: Cognitive Level: Analysis | Integrated Processes: Teaching/Learning | Client Need: Psychosocial Integrity

A nursing student is observing an electroconvulsive therapy (ECT) procedure. The student notices a blood pressure cuff on the client's lower leg. The student questions the instructor about the cuff placement. Which is the most accurate instructor reply? A. "The cuff has to be placed on the leg because both arms are used for intravenous fluids." B. "The cuff functions to prevent succinylcholine from reaching the foot." C. "The cuff position gives a more accurate blood pressure reading during the treatment." D. "The cuff is placed on the leg so that arms can easily be restrained during seizure."

ANS: B A blood pressure cuff is placed on the lower leg and inflated above systolic pressure before injection of succinylcholine. This is to ensure that seizure activity can be observed and timed in this one limb that is unaffected by the paralytic agent. KEY: Cognitive Level: Application | Integrated Processes: Teaching/Learning | Client Need: Safe and Effective Care Environment

Which is a correctly written, appropriate outcome for a client with a history of suicide attempts who is currently exhibiting symptoms of low self-esteem by isolating self? A. The client will not physically harm self. B. The client will express three positive self-attributes by day 4. C. The client will reveal a suicide plan. D. The client will establish a trusting relationship.

ANS: B Although the client has a history of suicide attempts, the current problem is isolative behaviors based on low self-esteem. Outcomes should be client centered, specific, realistic, and measureable and contain a time frame. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Planning | Client Need: Psychosocial Integrity

During a psychoeducational group on assertiveness training, a client asks, "Why do we need to learn about this stuff?" Which is the most appropriate nursing reply? A. "Because your doctor requires you to attend this group." B. "Being assertive is the ability to stand up for yourself while respecting the rights of others." C. "Assertiveness training teaches you how to ask for what you want, when you want it." D. "Assertive people place the needs and rights of others before their own."

ANS: B Assertiveness training assists people to maintain their own self-respect and meet their needs while respecting the rights of others. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A stockbroker commits suicide after being convicted of insider trading. In speaking with the family, which statement by the nurse demonstrates accurate and appropriate sharing of information? A. "Your grieving will subside within 1 year; until then I recommend antidepressants." B. "Support groups are available specifically for survivors of suicide, and I would be glad to help you locate one in this area." C. "The only way to deal effectively with this kind of grief is to write a letter to the brokerage firm to express your anger with them." D. "Since stigmatization often occurs in these situations, it would be best if you avoid discussing the suicide with anyone."

ANS: B Bereavement following suicide is complicated by the complex psychological impact of the act on those close to the victim. Support groups for survivors can provide a meaningful resource for grief work. KEY: Cognitive Level: Application | Integrated Processes: Teaching/Learning | Client Need: Psychosocial Integrity

Which symptom should a nurse identify as typical of the "fight-or-flight" response? A. Pupil constriction B. Increased heart rate C. Increased salivation D. Increased peristalsis

ANS: B During the "fight-or-flight" response, the heart rate increases in response to the release of epinephrine. Pupils dilate to enhance vision. Salivation and peristalsis decrease as the body slows unessential functions. OK KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Assessment | Client Need: Physiological Integrity

A nursing instructor is teaching about electroconvulsive therapy (ECT). Which student statement indicates that learning has occurred? A. "During ECT a state of euphoria is induced." B. "ECT induces a grand mal seizure." C. "During ECT a state of catatonia is induced." D. "ECT induces a petit mal seizure."

ANS: B Electroconvulsive therapy is the induction of a grand mal seizure through the application of electrical current to the brain for the purpose of decreasing depression. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Physiological Integrity

Parents of a 3-year-old have noticed an improvement in behavior because of using a "time out" behavioral approach. What aspect of "time out" therapy may be responsible for this child's improved behavior? A. "Negative reinforcement discourages maladaptive behavior." B. "Positive reinforcement is removed." C. "Covert sensitization is being applied." D. "Reciprocal inhibition is eliminated."

ANS: B In a "time out," the positive reinforcement of attention is removed from the child during inappropriate behavior. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

An adolescent client was recently admitted to the psychiatric unit because of impulsivity and acting-out behavior at school. The nurse should initially implement which nursing action? A. Redirect the client to activities to decrease stress. B. Explain the unit rules and consequences of breaking the rules. C. Place the client on close observation to insure a trusting relationship. D. Administer an anti-anxiety medication.

ANS: B It is important for the nurse to initially explain the unit rules and consequences of breaking the rules. It is imperative that consequences of rule infractions are explained early in treatment to avoid misunderstanding and manipulation. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

Which nursing approach is likely to be most therapeutic when dealing with a newly admitted, hostile, suspicious client? A. Place a hand on the client's shoulder and state, "I will help you to your room." B. Slowly and matter-of-factly state, "I am your nurse and I will show you to your room." C. Firmly set limits by stating, "If your behavior does not improve you will be secluded." D. Smile and state, "I am your nurse. When do you want to go to your room?"

ANS: B It is important to maintain an unemotional tone of voice when dealing with a hostile client. The client might misinterpret touch and become violent. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A 29-year-old client living with parents has few interpersonal relationships. The client states, "I have trouble trusting people." Based on Erikson's developmental theory, which should the nurse recognize as a true statement about this client? A. The client has not progressed beyond the trust versus mistrust developmental stage. B. Developmental deficits in earlier life stages have impaired the client's adult functioning. C. The client cannot move to the next developmental stage until mastering all earlier stages. D. The client's developmental problems began in the intimacy versus isolation stage.

ANS: B Many individuals with mental health problems are still struggling to achieve tasks from a number of developmental stages. Nurses can plan care to assist these individuals to complete these tasks and move on to a higher developmental level. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Analysis | Client Need: Psychosocial Integrity

An adolescent comes from a dysfunctional family where physical and verbal abuse prevails. At school this adolescent bullies and fights with classmates. According to principles of behavior therapy, what is the probable source of this behavior? A. Shaping B. Modeling C. Premack principle D. Reciprocal inhibition

ANS: B Modeling is the learning of new behaviors by imitating the behaviors of others. This adolescent, witnessing physical and verbal abuse in the home, models this behavior in school. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Analysis | Client Need: Psychosocial Integrity

A nursing instructor is teaching about the behavior technique of modeling. When asked to give an example of this behavioral intervention, which student statement meets the learning objective? A. "A child is first rewarded for using a spoon to eat and then rewarded for using a fork, and finally rewarded for cutting food with a knife." B. "An adolescent imitates Dad by using and caring for tools appropriately." C. "A client and therapist agree to conditions of therapy, stating explicitly in writing the behavior change that is desired." D. "A mother tells her child that television can be watched only after homework is completed."

ANS: B Modeling refers to the learning of new behaviors by imitating the behavior of others. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

A client states, "My doctor has told me I am a candidate for electroconvulsive therapy (ECT). Where will the treatment take place, and how much time would this entail?" Which is the most accurate nursing reply? A. "Clients typically receive ECT in their hospital room, daily for 1 month." B. "Clients typically undergo 6 to 12 ECT procedures, three times a week in an outpatient setting." C. "Clients typically receive an unlimited number of treatments, in the hospital procedure room." D. "Clients typically receive two to three treatments, in either an outpatient or inpatient setting."

ANS: B Most clients require an average of 6 to 12 ECT procedures, but some may require up to 20 procedures. Treatments are usually administered every other day, three times per week. Treatments are performed on either an inpatient or outpatient basis, depending on the need for client monitoring. KEY: Cognitive Level: Application | Integrated Processes: Teaching/Learning | Client Need: Safe and Effective Care Environment

A client who experiences stress on a regular basis asks a nurse what causes these feelings. Which is the most appropriate nursing response? A. "Genetics have nothing to do with your temperament." B. "How you reacted to past experiences influences how you feel now." C. "If you're in good physical health, your stress level will be low." D. "Stress can always be avoided if appropriate coping mechanisms are employed."

ANS: B Past experiences are occurrences that result in learned patterns that can influence an individual's current adaptation response. They include previous exposure to the stressor or other stressors in general, learned coping responses, and degree of adaptation to previous stressors. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A school nurse is assessing a distraught female high school student who is overly concerned because her parents can't afford horseback riding lessons. How should the nurse interpret the student's reaction to her perceived problem? A. The problem is endangering her well-being. B. The problem is personally relevant to her. C. The problem is based on immaturity. D. The problem is exceeding her capacity to cope.

ANS: B Psychological stressors to self-esteem and self-image are related to how the individual perceives the situation or event. Self-image is of particular importance to adolescents, who feel entitled to have all the advantages that other adolescents experience. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

A client is diagnosed with an anxiety disorder. The nurse counselor recommends intervention with the behavioral technique of reciprocal inhibition. The client asks, "What's that?" Which is the most appropriate nursing reply? A. "At the beginning of this intervention, a contract will be drawn up explicitly stating the behavior change agreed upon." B. "By introducing an adaptive behavior that is mutually exclusive to your maladaptive behavior, we will expect subsequent behavior to improve." C. "Through a series of increasingly anxiety-provoking steps, we will gradually increase your tolerance to anxiety." D. "In one intense session, you will be exposed to a maximum level of anxiety that you will learn to tolerate."

ANS: B Reciprocal inhibition decreases or eliminates an undesired behavior by introducing a more adaptive behavior that is incompatible with the undesired behavior. KEY: Cognitive Level: Application | Integrated Process: Teaching/Learning | Client Need: Psychosocial Integrity

A psychiatric nurse uses Sullivan's theories in group and individual therapy. According to Sullivan and other theorists like him, how are client symptoms viewed? A. Client symptoms are viewed as learned behaviors that are maintained because they are reinforced. B. Client symptoms are viewed as responses to anxiety arising from interpersonal relationships. C. Client symptoms are viewed as internal conflicts arising from early childhood trauma. D. Client symptoms are viewed as the misinterpretations of experiences.

ANS: B Sullivan believed that anxiety is the chief disruptive force in interpersonal relations and the main factor in the development of serious difficulty in living. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Analysis | Client Need: Psychosocial Integrity

Which statement is most likely to be made by a nurse practitioner who shares the philosophy of an interpersonal theorist? A. "Let's discuss your use of defense mechanisms." B. "We need to examine how your relationships affect your ability to cope." C. "It is important that you take the medications that I have prescribed for you." D. "Your genetic background is a factor in your predisposition to mental illness."

ANS: B Sullivan, an interpersonal theorist, believed that individual behavior and personality development are the direct result of interpersonal relationships. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

From an interpersonal theory perspective, which intervention would a nurse use to assist a client diagnosed with major depressive disorder? A. Encourage discussion of feelings B. Offer family therapy sessions C. Discuss childhood events D. Teach alternate coping skills

ANS: B Sullivan, an interpersonal theorist, believed that individual behavior and personality development are the direct result of interpersonal relationships. Family therapy would assist the client to deal with relationships within the family system. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

According to behavioral theory, the treatment of phobic symptoms should involve which action? A. The manipulation of the environment B. The use of desensitization C. The use of family therapy D. The uncovering of past events

ANS: B Systematic desensitization is a technique for assisting individuals to overcome their fear of a phobic stimulus. It is "systematic" in that there is a hierarchy of anxiety-producing events through which the individual progresses during therapy. KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Implementation | Client Need: Psychosocial Integrity

What is the main goal of the working phase of the nurse-client therapeutic relationship? A. Role modeling to improve interaction with others B. Resolution of the client's problems C. Using therapeutic communication to clarify perceptions D. Helping the client access outpatient treatment

ANS: B The goal of the working phase of the nurse-client therapeutic relationship is to resolve client problems by promoting behavioral change. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A nurse recently admitted a client to an inpatient unit after a suicide attempt. A health-care provider orders amitriptyline (Elavil) for the client. Which intervention related to this medication should be initiated to maintain this client's safety upon discharge? A. Provide a 6-month supply of Elavil to ensure long-term compliance. B. Provide a 1-week supply of Elavil with refills contingent on follow-up appointments. C. Provide a pill dispenser as a memory aid. D. Provide education regarding the avoidance of foods containing tyramine.

ANS: B The health-care provider should provide a 1-week supply of Elavil with refills contingent on follow-up appointments as an appropriate intervention to maintain the client's safety. Tricyclic antidepressants have a narrow therapeutic range and can be used in overdose to commit suicide. Distributing limited amounts of the medication decreases this potential. KEY: Cognitive Level: Application | Integrated Processes: Communication and Documentation | Client Need: Safe and Effective Care Environment: Management of Care

A client is scheduled for an initial electroconvulsive therapy (ECT) procedure. Which information should a nurse include when teaching about the potential side effects of this procedure? A. "You may experience transient tangential thinking." B. "You may experience some memory deficit surrounding the ECT." C. "You may experience avolution for the remainder of the day." D. "You may experience a higher risk for subsequent seizures."

ANS: B The most common side effect of ECT is temporary amnesia following the ECT procedure. KEY: Cognitive Level: Application | Integrated Processes: Teaching/Learning | Client Need: Safe and Effective Care Environment

Which nursing behavior will enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia? A. Establishing personal contact with family members. B. Being reliable, honest, and consistent during interactions. C. Sharing limited personal information. D. Sitting close to the client to establish rapport.

ANS: B The nurse can enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia by being reliable, honest, and consistent during interactions. The nurse should also convey acceptance of the client's needs and maintain a calm attitude when dealing with agitated behavior. PTS: 1 REF: Pages: 331-336 KEY: Cognitive Level: Comprehension | Integrated Process: Nursing Process: Implementation

During an admission assessment, a nurse asks a client diagnosed with schizophrenia, "Have you ever felt that certain objects or persons have control over your behavior?" For which type of thought disruption is the nurse assessing? A. Delusion of persecution B. Delusions of influence C. Delusions of reference D. Delusions of grandeur

ANS: B The nurse is assessing the client for delusions of influence when asking if the client has ever felt that objects or persons have control of behavior. Delusions of control or influence occur when the client believes that behavior is being controlled. An example would be if a client believes that a hearing aid receives transmissions that control thoughts and behaviors. PTS: 1 REF: Page: 327 KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Assessment

Which statement indicates that the nurse is acting as an advocate for a client who was hospitalized after a suicide attempt and is now nearing discharge? A. "I must observe you continually for 1 hour in order to keep you safe." B. "Let's confer with the treatment team about the resources that you may need after discharge." C. "You must have been very upset to do what you did today." D. "Are you currently thinking about harming yourself?"

ANS: B The nurse is functioning in an advocacy role when collaborating with the client and treatment team to discuss client problems and needs. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A hungry, homeless client, diagnosed with schizophrenia, refuses to participate in an admission interview. When the nurse postpones the admission interview, verbally assures safety, and provides a warm meal, he or she is promoting which of the following? A. Sympathy B. Trust C. Veracity D. Manipulation

ANS: B The nurse is promoting trust by postponing the admission interview, assuring safety, and providing a warm meal. Trust implies a feeling of confidence that a person is reliable and sincere and has integrity and veracity. Trustworthiness is demonstrated through nursing interventions that convey a sense of warmth and caring to the client. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A nurse is caring for a hospitalized client who is quarrelsome and opinionated and has little regard for others. According to Sullivan's interpersonal theory, the nurse should associate the client's behaviors with a previous deficit in which stage of development? A. Infancy B. Childhood C. Early adolescence D. Late adolescence

ANS: B The nurse should associate the client's behavior with a deficit in the childhood stage of Sullivan's interpersonal theory. The childhood stage in Sullivan's interpersonal theory typically occurs from the ages of 18 months to 6 years of age, during which the child learns to experience a delay in personal gratification without undue anxiety. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Analysis | Client Need: Psychosocial Integrity

According to Freud, which statement should a nurse associate with predominance of the superego? A. "No one is looking, so I will take three cigarettes from Mom's pack." B. "I don't ever cheat on tests; it is wrong." C. "If I skip school I will get in trouble and fail my test." D. "Dad won't miss this little bit of vodka."

ANS: B The nurse should associate the statement "I don't ever cheat on tests; it is wrong" as indicative of the predominance of the superego. Freud described the superego as the part of the personality that internalizes the values and morals set forth by primary caregivers. The superego can be referred to as the "perfection principle." KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Analysis | Client Need: Psychosocial Integrity

A client diagnosed with schizophrenia tells a nurse, "The 'Shopatouliens' took my shoes out of my room last night." Which is an appropriate charting entry to describe this client's statement? A. "The client is experiencing command hallucinations." B. "The client is expressing a neologism." C. "The client is experiencing a paranoid delusion." D. "The client is verbalizing a word salad."

ANS: B The nurse should describe the client's statement as experiencing a neologism. A neologism is when a client invents a new word that is meaningless to others but may have symbolic meaning to the client. Word salad refers to a group of words that are put together randomly. PTS: 1 REF: Page: 328 KEY: Cognitive Level: Comprehension | Integrated Process: Communication/Documentation

A 1-month-old infant is left alone for extended periods, has little physical stimulation, and is malnourished. Based on this infant's history, in which phase of development according to Mahler's theory should a nurse expect to see a potential deficit? A. The symbiotic phase B. The autistic phase C. The consolidation phase D. The rapprochement phase

ANS: B The nurse should expect that a 1-month-old infant who is left alone, has little physical stimulation, and is malnourished would not meet the autistic phase of development. The autistic phase of development usually occurs from birth to 1 month, at which time the infant's focus is on basic needs and comfort. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

If an individual is "two-faced," which characteristic essential to the development of a therapeutic relationship should a nurse identify as missing? A. Respect B. Genuineness C. Sympathy D. Rapport

ANS: B The nurse should identify that genuineness is missing in the relationship. Genuineness refers to an individual's ability to be open and honest and maintain congruence between what is felt and what is communicated. Genuineness is essential to establishing trust in a relationship. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

A paranoid client presents with bizarre behaviors, neologisms, and thought insertion. Which nursing action should be prioritized to maintain this client's safety? A. Assess for medication noncompliance. B. Note escalating behaviors and intervene immediately. C. Interpret attempts at communication. D. Assess triggers for bizarre, inappropriate behaviors.

ANS: B The nurse should note escalating behaviors and intervene immediately to maintain this client's safety. Early intervention may prevent an aggressive response and keep the client and others safe. PTS: 1 REF: Page: 324 KEY: Cognitive Level: Analysis | Integrated Process: Nursing Process: Implementation

A client diagnosed with paranoid schizophrenia becomes agitated when asked to play a game. The client responds, "Do you want to be my girlfriend?" Which nursing response is most appropriate? A. "You are upset now. It would be best if you go to your room until you feel better." B. "Remember, we have a professional relationship. Are you feeling uncomfortable?" C. "We have discussed this before. I am not allowed to date clients." D. "I think you should discuss your fantasies with your therapist."

ANS: B The nurse should promote the client's insight and perception of reality by confirming appropriate roles in the nurse-client relationship and identifying what is troubling the client in this situation. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A nurse is caring for a client who is experiencing a flat affect, paranoid delusions, anhedonia, anergia, neologisms, and echolalia. Which statement correctly differentiates the client's positive and negative symptoms of schizophrenia? A. Paranoid delusions, anhedonia, and anergia are positive symptoms of schizophrenia. B. Paranoid delusions, neologisms, and echolalia are positive symptoms of schizophrenia. C. Paranoid delusions, anergia, and echolalia are negative symptoms of schizophrenia. D. Paranoid delusions, flat affect, and anhedonia are negative symptoms of schizophrenia.

ANS: B The nurse should recognize that positive symptoms of schizophrenia include paranoid delusions, neologisms, and echolalia. The negative symptoms of schizophrenia include flat affect, anhedonia, and anergia. Positive symptoms reflect an excess or distortion of normal functions. Negative symptoms reflect a diminution or loss of normal functions. PTS: 1 REF: Page: 319 | Page: 324 | Pages: 328-330 KEY: Cognitive Level: Comprehension | Integrated Process: Nursing Process: Implementation

A nurse observes a 3-year-old client willingly sharing candy with a sibling. According to Peplau, which psychological stage of development should the nurse recognize that this child has completed? A. "Learning to count on others" B. "Learning to delay satisfaction" C. "Identifying oneself" D. "Developing skills in participation"

ANS: B The nurse should recognize that this client has completed the "Learning to delay satisfaction" stage of development according to Peplau's interpersonal theory. This stage typically occurs in toddlerhood when one learns the satisfaction of pleasing others. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

When assessing clients, a psychiatric nurse should understand that psychoanalytic theory is based on which underlying concept? A. A possible genetic basis for the client problems B. The structure and dynamics of the personality C. Behavioral responses to stressors D. Maladaptive cognitions

ANS: B The nurse should understand that psychoanalytic theory is based on the underlying concepts of the structure and dynamics of personality. Psychoanalytic theory was developed by Sigmund Freud and explains the structure of personality in three different components: the id, ego, and superego. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment |Client Need: Psychosocial Integrity

Which nursing action demonstrates the role of the teacher in a therapeutic milieu? A. The nurse implements a self-affirmation exercise during a one-to-one client interaction. B. The nurse holds a group meeting to present common side effects of psychiatric medications. C. The nurse introduces the concept of fair play while playing cards with a group of clients. D. The nurse models adaptive and effective coping mechanisms with clients on the psychiatric unit.

ANS: B The nurse, in the role of teacher, identifies learning needs and provides information required by the client or family to improve the client's health. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A bright student confides in the school nurse about conflicts related to attending college or working to add needed financial support to the family. Which coping strategy is most appropriate for the nurse to recommend to the student at this time? A. Meditation B. Problem-solving training C. Relaxation D. Journaling

ANS: B The student must assess his or her situation and determine the best course of action. Problem-solving training, by providing structure and objectivity, can assist in decision making. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

After years of dialysis, an 84-year-old states, "I'm exhausted, depressed, and done with these attempts to keep me alive." Which question should the nurse ask the spouse when preparing a discharge plan of care? A. "Have there been any changes in appetite or sleep?" B. "How often is your spouse left alone?" C. "Has your spouse been following a diet and exercise program consistently?" D. "How would you characterize your relationship with your spouse?"

ANS: B This client has many risk factors for suicide. The client should have increased supervision to decrease likelihood of self-harm. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment

A nursing instructor is teaching about suicide in the elderly population. Which information should the instructor include? A. Elderly people use less lethal means to commit suicide. B. Although the elderly make up less than 13% of the population, they account for 16% of all suicides. C. Suicide is the second leading cause of death among the elderly. D. It is normal for elderly individuals to express a desire to die, because they have come to terms with their mortality.

ANS: B This factual information should be included in the nursing instructor's teaching plan. An expressed desire to die is not normal in any age group. KEY: Cognitive Level: Application | Integrated Processes: Teaching/Learning | Client Need: Safe and Effective Care Environment

A client continually waits more than an hour before being seen at the mental health clinic. The client approaches the nurse and states, "When I have to wait for more than an hour to be seen, I feel like my time is not important." The nurse recognizes this as what type of behavior? A. Aggressive behavior B. Assertive behavior C. Passive-aggressive behavior D. Passive behavior

ANS: B This response is assertive. The client is openly expressing feelings and attempting to correct a stressful situation. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

An emergency department nurse, who has worked 10 straight days, is pulled to the psychiatric unit. Which represents a passive-aggressive statement by the emergency department nurse? A. "Get someone else to work 3 to 11! I've been working 10 days straight, and I need a break!" B. "Okay. I'll do it," then purposefully leaves paperwork undone when leaving the unit at 11 p.m. C. "I have worked 10 days straight, and I cannot work tonight. I will work for you tomorrow if you need me." D. "Yes, I'll do it. Anything to keep peace with the hospital administration is a good thing." An emergency department nurse, who has worked 10 straight days, is pulled to the psychiatric unit. Which represents a passive-aggressive statement by the emergency department nurse? A. "Get someone else to work 3 to 11! I've been working 10 days straight, and I need a break!" B. "Okay. I'll do it," then purposefully leaves paperwork undone when leaving the unit at 11 p.m. C. "I have worked 10 days straight, and I cannot work tonight. I will work for you tomorrow if you need me." D. "Yes, I'll do it. Anything to keep peace with the hospital administration is a good thing."

ANS: B This response is passive-aggressive. The staff nurse's anger is expressed indirectly. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A teenager gets a "C" in algebra. The mother angrily states, "All you ever do is listen to music and text your friends." The teenager replies, "What is it that you're really upset about, mom?" Which response pattern is the teenager expressing? A. Clouding and fogging B. Shifting from content to process C. Delaying assertively D. Assuming responsibility for one's own statements

ANS: B This response reflects the use of shifting from content to process. The teenager is changing the focus of the communication from discussing the topic at hand to analyzing what is actually going on in the interaction. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

Which risk factor should a nurse recognize as the most reliable indicator of potential client violence? A. A diagnosis of schizotypal personality disorder B. History of assaultive behavior C. Family history of violence D. Recent eviction from a homeless shelter

ANS: B A prior history of assault is the most widely recognized risk factor for client violence. KEY: Cognitive Level: Comprehension| Integrated Processes: Nursing Process: Assessment | Client Need: Safe and Effective Care Environment

The nurse observes a client's escalating anger. The client begins to pace the hall and shouts, "You all better watch out. I'm going to hurt anyone who gets in my way." Which should be the priority nursing intervention? A. Calmly tell the client, "Staff will help you to control your impulse to hurt others." B. Remove other clients from the area and maintain milieu safety. C. Gather a show of force by contacting security for assistance. D. Calmly tell the client, "You will need to be medicated and secluded."

ANS: B During an emergent situation on an inpatient unit, the nurse's priority action should be to keep all clients safe by removing them from the area of conflict. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment

A nursing instructor is teaching about the concept of anger. Which student statement indicates the need for further instruction? A. "Anger is physiological arousal." B. "Anger and aggression are essentially the same." C. "Anger expression is a learned response." D. "Anger is not a primary emotion."

ANS: B Further teaching is necessary when the student states that anger and aggression are essentially the same. Anger and aggression are significantly different. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

Once the nurse initiates restraint for an out-of-control 45-year-old patient, what must occur within 1 hour, according to JCAHO standards? A. The patient must be let out of restraint. B. A physician or other licensed independent practitioner must conduct an in-person evaluation. C. The patient must be bathed and fed. D. The patient must be included in debriefing.

ANS: B Joint Commission (JCAHO) standards require that a physician or other licensed independent practitioner conduct an in-person evaluation of the client within 1 hour of the initiation of restraint. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment

For select clients, physical restraint is considered to be a beneficial intervention. This is based on which premise? A. Clients with poor boundaries do not respond to verbal redirection, and they need firm and consistent limit setting. B. Clients with limited internal control over their behavior need external controls to prevent harm to themselves and others. C. Clients with antisocial tendencies need to submit to authority. D. Clients with behavioral dysfunction need behavioral interventions.

ANS: B Restraints are used for clients who are unable to control their behavior in order to prevent harming themselves or others. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Safe and Effective Care Environment

On an inpatient psychiatric unit, a restrained 16-year-old client continues to verbally lash out and threatens to abuse staff and kill self when released. To meet Joint Commission standards, at what time should a nurse expect the physician to renew the client's restraint order? A. Within 1 hour of the original restraint order B. Within 2 hours of the original restraint order C. Within 3 hours of the original restraint order D. Within 4 hours of the original restraint order

ANS: B The Joint Commission (JCAHO) requires that a physician or a licensed independent practitioner reissue a new order for restraints every 4 hours for adults, every 2 hours for adolescents, and every 1 hour for children. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment

A student nurse has just entered a psychiatric rotation. The student asks a nursing instructor, "How will we know if someone may get violent?" Which is the most appropriate reply by the nursing instructor? A. "You can't really say for sure. There are limited indicators of potential violence." B. "Certain behaviors indicate a potential for violence. They are labeled as a 'prodromal syndrome' and include rigid posture, clenched fists, and raised voice." C. "Any client can become violent, so it is best to be aware of your surroundings at all times." D. "When a client suddenly becomes quiet, is withdrawn, and maintains a flat affect, this is an indicator of potential violence."

ANS: B These behaviors have been identified as predictors of violent behavior. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Safe and Effective Care Environment

An adult client assaults another client and is placed in restraints. Which statement from the client while in restraints should alert a nurse that further assessment is necessary? A. "I hate all of you!" B. "My fingers are tingly." C. "You wait until I tell my lawyer." D. "I have a sinus headache."

ANS: B This statement may mean that the restraints are excessively tight and impeding circulation. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Physiological Integrity

At 3 a.m., when less restrictive methods fail, a physician orders restraints for an angry, aggressive client. To meet Joint Commission standards, at what time and by whom should a nurse expect an in-person client evaluation? A. No later than 8 a.m., by a licensed independent practitioner or a clinical nurse specialist B. No later than 4 a.m., by a physician or a licensed independent practitioner (LIP) C. No later than 3:30 a.m., by a physician or the client's case manager D. No later than 6 a.m., by the psychiatrist or a clinical nurse specialist

ANS: B To meet Joint Commission standards, an in-person evaluation by a physician or LIP should be conducted within 1 hour of the initiation of restraints. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment

A nursing instructor is teaching about violence-intervention protocols. Which student statement would indicate the need for further instruction? A. "Administering psychotropic medications can be a part of violence-intervention protocols." B. "Soothing the client by stroking an arm or shoulder can be a part of violence-intervention protocols." C. "Applying leather restraints can be a part of violence-intervention protocols." D. "Calling for assistance is a part of violence-intervention protocols."

ANS: B Touching the client could be seen by him or her as threatening and provoke further violence. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Safe and Effective Care Environment

The nurse-client therapeutic relationship includes which of the following characteristics? Select all that apply. A. Meeting the psychological needs of the nurse and the client B. Ensuring therapeutic termination C. Promoting client insight into problematic behavior D. Collaborating to set appropriate goals E. Meeting both the physical and psychological needs of the client

ANS: B, C, D, E The nurse-client therapeutic relationship should include promoting client insight into problematic behavior, collaboration to set appropriate goals, meeting the physical and psychological needs of the client, and ensuring therapeutic termination. The nurse's psychological needs should not be addressed within the nurse-client relationship. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A patient presents in the Emergency Department immediately following a shooting incident in a school where she has been teaching. There is no evidence of physical injury, but she appears very hyperactive and talkative. Which of these symptoms manifested by the patient are common initial biological responses to stress? Select all that apply. A. Constricted pupils B. Watery eyes C. Unusual food cravings D. Increased heart rate E. Increased respirations

ANS: B, D, E Increased lacrimal secretions, increased heart rate, and increased respirations are identified as initial biological responses to stress. Since dilated pupils rather than constricted pupils are related to "Fight or Flight" syndrome, this symptom should be assessed for other potential causes. Unusual food cravings have not been identified as a typical biological response to stress. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Assessment | Client Need: Physiological Integrity

A 2-year-old engages in frequent temper tantrums that usually result in the parents giving in to demands. During family therapy, how should a nurse counsel the parents? A. "You are shaping your child's behavior." B. "Your child has modeled your behavior." C. "You are positively reinforcing your child's behavior." D. "You are negatively reinforcing your child's behavior."

ANS: C KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A client with cognitive deficits is extremely suicidal. The client has not responded to antidepressants and the treatment team is considering electroconvulsive therapy (ECT). What client information would impact the feasibility of this treatment option? A. Because the client is extremely suicidal, ECT is an appropriate option. B. Because antidepressant medications have been ineffective, ECT is a good alternative. C. Because informed consent is required for ECT, cognitive deficits could preclude this option. D. Because of the client's cognitive deficits, a signed consent is waived.

ANS: C A client who is experiencing cognitive deficits cannot give informed consent, which is required prior to ECT. A court proceeding could determine the client's level of competency and, if necessary, the judge would appoint a guardian. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Evaluation | Client Need: Safe and Effective Care Environment

Which client data indicate that a suicidal client is participating in a plan for safety? A. Compliance with antidepressant therapy B. A mood rating of 9/10 C. Disclosing a plan for suicide to staff D. Expressing feelings of hopelessness to nurse

ANS: C A degree of the responsibility for the suicidal client's safety is given to the client. When a client shares with staff a plan for suicide, the client is participating in a plan for safety by communicating thoughts of self-harm that would initiate interventions to prevent suicide. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

A client is newly admitted to an inpatient psychiatric unit. Which of the following is most critical to assess when determining risk for suicide? A. Family history of depression B. The client's orientation to reality C. The client's history of suicide attempts D. Family support systems

ANS: C A history of suicide attempts places a client at a higher risk for current suicide behaviors. Knowing this specific data will alert the nurse to the client's risk. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Assessment | Client Need: Safe and Effective Care Environment

A nursing student finds that she comes down with a sinus infection toward the end of every semester. When this occurs, which stage of stress is the student most likely experiencing? A. Alarm reaction stage B. Stage of resistance C. Stage of exhaustion D. Fight-or-flight stage

ANS: C At the stage of exhaustion, the student's exposure to stress has been prolonged and adaptive energy has been depleted. Diseases of adaptation occur more frequently in this stage. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A client who is learning about electroconvulsive therapy (ECT) asks a nurse, "Isn't this treatment dangerous?" Which is the most appropriate nursing reply? A. "No, this treatment is side-effect free." B. "There can be temporary paralysis, but full functioning returns within 3 hours of treatment." C. "There are some risks, but a thorough examination will determine your candidacy for ECT." D. "Transient ischemic attacks (TIAs) can occur but are rare."

ANS: C Clients are given medical clearance for ECT. This decreases the risk of injury from the treatment. KEY: Cognitive Level: Application | Integrated Processes: Teaching/Learning | Client Need: Physiological Integrity: Reduction of Risk Potential

A mother tells her teenager that in order for college tuition to be paid, the teenager must quit smoking. They develop a written agreement stipulating time frames and consequences. This is an example of which technique of behavior modification? A. Shaping B. Modeling C. Contracting D. Premack principle

ANS: C Contracting occurs when the mother and teenager together develop a written agreement related to desired behavior (smoking cessation) and positive reinforcement (paid college tuition). KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A nurse should assign which nursing diagnosis to a client needing assistance with assertiveness? A. Disturbed personal identity B. Disturbed thought processes C. Defensive coping D. Impaired verbal communication

ANS: C Defensive coping reflects a self-protective pattern that defends against underlying perceived threats to positive self-regard. Clients who are utilizing defensive coping lack assertiveness skills. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Analysis | Client Need: Psychosocial Integrity

A nurse is caring for four clients diagnosed with major depressive disorder. When considering each client's belief system, the nurse should conclude which client would potentially be at highest risk for suicide? A. Roman Catholic B. Protestant C. Atheist D. Muslim

ANS: C Depressed men and women who consider themselves affiliated with a religion are less likely to attempt suicide than their nonreligious counterparts. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Analysis | Client Need: Safe and Effective Care Environment

An unemployed college graduate is experiencing severe anxiety over not finding a teaching position and has difficulty with independent problem-solving. During a routine physical examination, the graduate confides in the clinic nurse. Which is the most appropriate nursing intervention? A. Encourage the student to use the alternative coping mechanism of relaxation exercises. B. Complete the problem-solving process for the client. C. Work through the problem-solving process with the client. D. Encourage the client to keep a journal.

ANS: C During times of high anxiety and stress, clients will need more assistance in problem-solving and decision making. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

During hospitalization, an attention-seeking client has repeatedly cut herself. After threatening to cut herself again, the nurse states, "Here are some Band-Aids so you won't bleed on the sheets." Which is the underlying reason for this nurse's response? A. The nurse is using an aversive stimulus in response to the client's manipulative cutting behavior. B. The nurse is using negative reinforcement in response to the client's behavior. C. The nurse is minimizing reinforcement of the client's manipulative behavior with the goal of extinction. D. The nurse lacks empathy for the client's recurring self-injurious behavior.

ANS: C Extinction is the gradual decrease in frequency or disappearance of a response when a positive reinforcement is withheld. The nurse is withholding attention to the client who is exhibiting manipulative, attention-seeking behavior. The lack of positive response (attention) should cause extinction of the undesired behavior. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A nursing instructor is teaching about the medications given prior to and during electroconvulsive therapy (ECT). Which student statement indicates that learning has occurred? A. "Atropine (Atro-Pen) is administered to paralyze skeletal muscles during ECT." B. "Succinylcholine chloride (Anectine) decreases secretions to prevent aspiration." C. "Thiopental sodium (Pentothal) is a short-acting anesthesia to render the client unconscious." D. "Glycopyrrolate (Robinul) is given to prevent severe muscle contractions during seizure."

ANS: C In order to render a client unconscious during the ECT procedure, an anesthesiologist administers intravenously a short-acting anesthetic such as thiopental sodium (Pentothal). KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies

A nursing instructor is teaching about self-concept. Which student statement indicates a need for further instruction? A. Self-concept is the thinking component of the self. B. Self-concept is a system of learned beliefs about self. C. Self-concept is the degree of regard that individuals have for themselves. D. Self-concept is the attitudes and opinions held true about personal existence.

ANS: C Self-esteem, not self-concept, is the degree of regard that individuals have for themselves. This student statement indicates a need for further teaching. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

In a family that is in the life cycle stage called "The Family with Adolescents," which changes must occur for the family to proceed developmentally? A. Making adjustments within the marital system to meet the responsibilities of parenthood B. Establishing a new identity as a couple by realigning relationships with extended family C. Redefining the level of dependence so that adolescents are provided with greater autonomy D. Reestablishing the bond of the dyadic marital relationship

ANS: C Stage IV of the family life cycle is described as "The Family with Adolescents." The task of this stage is to redefine the level of dependence so that adolescents are provided with greater autonomy while parents remain responsive to teenagers' dependency needs. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A new nursing graduate asks the psychiatric nurse manager how to best classify suicide. Which is the nurse manager's best reply? A. "Suicide is a DSM-5 diagnosis." B. "Suicide is a mental disorder." C. "Suicide is a behavior." D. "Suicide is an antisocial affliction."

ANS: C Suicide is not a diagnosis, disorder, or affliction. It is a behavior. KEY: Cognitive Level: Application | Integrated Processes: Teaching/Learning | Client Need: Psychosocial Integrity

A client reports, "My friend panicked at the site of spiders. Her therapist used gradual exposure to spiders that initially made her increasingly more anxious." Which technique was the friend's therapist most likely using? A. Extinction B. Covert sensitization C. Systematic desensitization D. Reciprocal inhibition

ANS: C Systematic desensitization is a treatment for phobias in which a phobic individual is gradually exposed to increasing amounts of the phobic stimulus while practicing relaxation techniques. Eventually, the phobic stimulus causes little or no anxiety. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

Which client statement indicates that termination of the therapeutic nurse-client relationship has been handled successfully? A. "I know I can count on you for continued support." B. "I am looking forward to discharge, but I am surprised that we will no longer work together." C. "Reviewing the changes that have happened during our time together has helped me put things in perspective." D. "I don't know how comfortable I will feel when talking to someone else."

ANS: C Termination should begin in the orientation phase to minimize feelings of loss when the nurse-client relationship ends. Bringing a therapeutic conclusion to the relationship occurs when progress has been made toward attainment of mutually set goals. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

A nurse moving out of state speaks to a client about the need to work with a new nurse. The client states, "I'm not well enough to switch to a different nurse." What does this client response indicate to the nurse? A. The client is using manipulation to receive secondary gain. B. The client is using the defense mechanism of denial. C. The client is having trouble terminating the relationship. D. The client is using "splitting" as a way to remain dependent on the nurse.

ANS: C Termination should begin in the orientation phase to minimize feelings of loss when the nurse-client relationship ends. When a client feels sadness and loss, behaviors to delay termination may become evident. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

A client has experienced the death of a close family member and at the same time becomes unemployed. This situation has resulted in a 6-month score of 110 on the Recent Life Changes Questionnaire. How should the nurse evaluate this client data? A. The client is experiencing severe distress and is at risk for physical and psychological illness. B. A score of 110 on the Miller and Rahe Recent Life Changes Questionnaire indicates no significant threat of stress-related illness. C. Susceptibility to stress-related physical or psychological illness cannot be estimated without knowledge of coping resources and available supports. D. The client may view these losses as challenges and perceive them as opportunities.

ANS: C The Recent Life Changes Questionnaire is an expanded version of the Schedule of Recent Experiences and the Rahe-Holmes Social Readjustment Rating Scale. A 6-month score of 300 or more, or a year-score total of 500 or more, indicates high stress in a client's life. However, positive coping mechanisms and strong social support can limit susceptibility to stress-related illnesses. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

After undergoing two of nine electroconvulsive therapy (ECT) procedures, a client states, "I can't even remember eating breakfast, so I want to stop the ECT." Which is the most appropriate nursing reply? A. "After you begin the course of treatments, you must complete all of them." B. "You'll need to talk with your doctor about what you're thinking." C. "It is within your right to discontinue the treatments, but let's talk about your concerns." D. "Memory loss is a rare side effect of the treatment. I don't think it should be a concern."

ANS: C The client has the right to terminate treatment. This nursing reply acknowledges this right but focuses on the client's concerns so that the nurse can provide needed information. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment

Parents ask a nurse how they should reply when their child, diagnosed with paranoid schizophrenia, tells them that voices command him to harm others. Which is the appropriate nursing response? A. "Tell him to stop discussing the voices." B. "Ignore what he is saying, while attempting to discover the underlying cause." C. "Focus on the feelings generated by the hallucinations and present reality." D. "Present objective evidence that the voices are not real."

ANS: C The most appropriate response by the nurse is to instruct the parents to focus on the feelings generated by the hallucinations and present reality. The parents should maintain an attitude of acceptance to encourage communication but should not reinforce them by encouraging the client to accept that they are not real. PTS: 1 REF: Page: 331 KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Implementation

A client diagnosed with schizophrenia states, "Can't you hear him? It's the devil. He's telling me I'm going to hell." Which is the most appropriate nursing response? A. "Did you take your medicine this morning?" B. "You are not going to hell. You are a good person." C. "I'm sure the voices sound scary, but the devil is not talking to you. This is part of your illness." D. "The devil only talks to people who are receptive to his influence."

ANS: C The most appropriate response by the nurse is to reassure the client with an accepting attitude while not reinforcing the hallucination. Reminding the client that "the voices" are a part of the illness is a way to help the client accept that the hallucinations are not real. PTS: 1 REF: Page: 331 KEY: Cognitive Level: Analysis | Integrated Process: Nursing Process: Implementation

An aging client diagnosed with chronic schizophrenia takes an antipsychotic and a beta-adrenergic blocking agent (propranolol) for hypertension. Understanding the combined side effects of these drugs, which statement by a nurse is most appropriate? A. "Make sure you concentrate on taking slow, deep, cleansing breaths." B. "Watch your diet and try to engage in some regular physical activity." C. "Rise slowly when you change position from lying to sitting or sitting to standing." D. "Wear sunscreen and try to avoid midday sun exposure."

ANS: C The most appropriate statement by the nurse is to instruct the client to rise slowly when changing positions. Antipsychotic medications and beta blockers cause a decrease in blood pressure. When given in combination, this side effect places the client at risk for developing orthostatic hypotension. PTS: 1 KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Implementation

A nurse administers pure oxygen to a client during and after electroconvulsive therapy. What is the nurse's rationale for this procedure? A. To prevent increased intracranial pressure resulting from anoxia B. To prevent hypotension, bradycardia, and bradypnea due to electrical stimulation C. To prevent anoxia due to medication-induced paralysis of respiratory muscles D. To prevent blocked airway resulting from seizure activity

ANS: C The nurse administers 100% oxygen during and after electroconvulsive therapy to prevent anoxia due to medication-induced paralysis of respiratory muscles. Electroconvulsive therapy is the induction of a grand mal seizure through the application of electrical current to the brain. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Physiological Integrity

A client with a history of three suicide attempts has been taking fluoxetine (Prozac) for 1 month. The client suddenly presents with a bright affect, rates mood at 9/10, and is much more communicative. Which action should be the nurse's priority at this time? A. Give the client off-unit privileges as positive reinforcement. B. Encourage the client to share mood improvement in group. C. Increase frequency of client observation. D. Request that the psychiatrist reevaluate the current medication protocol.

ANS: C The nurse should be aware that a sudden increase in mood rating and change in affect could indicate that the client is at risk for suicide and client observation should be more frequent. Suicide risk may occur early during treatment with antidepressants. The return of energy may bring about an increased ability to act out self-destructive behaviors prior to attaining the full therapeutic effect of the antidepressant medication. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment: Management of Care

A client diagnosed with paranoid schizophrenia states, "My psychiatrist is out to get me. I'm sad that the voice is telling me to stop him." What symptom is the client exhibiting, and what is the nurse's legal responsibility related to this symptom? A. Magical thinking; administer an antipsychotic medication. B. Persecutory delusions; orient the client to reality. C. Command hallucinations; warn the psychiatrist. D. Altered thought processes; call an emergency treatment team meeting.

ANS: C The nurse should determine that the client is exhibiting command hallucinations. The nurse's legal responsibility is to warn the psychiatrist of the potential for harm. Clients demonstrating a risk for violence could potentially be physically, emotionally, and/or sexually harmful to others or to self. PTS: 1 REF: Page: 328 | Page: 331 KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Analysis

A client diagnosed with schizophrenia is slow to respond and appears to be listening to unseen others. Which medication should a nurse expect a physician to order to address this type of symptom? A. Haloperidol (Haldol) to address the negative symptom. B. Clonazepam (Klonopin) to address the positive symptom. C. Risperidone (Risperdal) to address the positive symptom. D. Clozapine (Clozaril) to address the negative symptom.

ANS: C The nurse should expect the physician to order risperidone (Risperdal) to address the positive symptoms of schizophrenia. Risperidone (Risperdal) is an atypical antipsychotic used to reduce positive symptoms, including disturbance in conduct of thought (delusions), form of thought (neologisms), or perception (hallucinations). PTS: 1 REF: Page: 337 KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Planning

A client has flashbacks of sexual abuse by her uncle. She had not been aware of these memories until recently, when she became sexually active with her boyfriend. A nurse should identify this experience as which part of Sullivan's concept of the self-system? A. The "good me" B. The "bad me" C. The "not me" D. The "bad you"

ANS: C The nurse should identify a client remembering sexual abuse when becoming sexually active with her boyfriend as experiencing the "not me" part of the personality. According to Sullivan, the "not me" part of the personality develops in response to situations that produced intense anxiety in childhood. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A father of a 5-year-old demeans and curses at his child for disobedience. In turn, when upset, the child uses swear words in kindergarten. A school nurse recognizes this behavior as unsuccessful completion of which stage of development according to Peplau? A. "Learning to count on others" B. "Learning to delay satisfaction" C. "Identifying oneself" D. "Developing skills in participation"

ANS: C The nurse should identify that the child using swear words in kindergarten has not successfully completed the "identifying oneself" stage according to Peplau's interpersonal theory. During this stage of early childhood, a child learns to structure self-concept by observing how others interact with him or her. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A 6-year-old boy uses his father's flashlight to explore his 3-year-old sister's genitalia. According to Freud, in which stage of psychosocial development should a nurse identify this behavior as normal? A. Oral B. Anal C. Phallic D. Latency

ANS: C The nurse should identify this behavior as normal because the 6-year-old client who focuses on genital organs is in the phallic stage of Freud's stages of psychosexual stages of development. Children in the phallic stage of development focus on genital organs and develop a sense of sexual identity. Identification with the same-sex parent also occurs at this stage. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A client is newly committed to an inpatient psychiatric unit. Which nursing intervention best lowers this client's risk for suicide? A. Encouraging participation in the milieu to promote hope B. Developing a strong personal relationship with the client C. Observing the client at intervals determined by assessed data D. Encouraging and redirecting the client to concentrate on happier times

ANS: C The nurse should observe the actively suicidal client continuously for the first hour after admission. After a full assessment the treatment team will determine the observation status of the client. Observation of the client allows the nurse to interrupt any observed suicidal behaviors. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment

A client diagnosed with schizoaffective disorder is admitted for social skills training. Which information should be included in the nurse's teaching? A. The side effects of medications B. Deep breathing techniques to decrease stress C. How to make eye contact when communicating D. How to be a leader

ANS: C The nurse should plan to teach the client how to make eye contact when communicating. Social skills, such as making eye contact, can assist clients in communicating needs and maintaining connectedness. PTS: 1 REF: Page: 324 KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Implementation

9. A client diagnosed with psychosis NOS tells a nurse about voices telling him to kill the president. Which nursing diagnosis should the nurse prioritize for this client? A. Disturbed sensory perception B. Altered thought processes C. Risk for violence: directed toward others D. Risk for injury

ANS: C The nurse should prioritize the diagnosis risk for violence: directed toward others. A client who hears voices telling him to kill someone is a risk of other-directed violence. Other risk factors for violence include aggressive body language, verbal aggression, catatonic excitement, and rage reactions. PTS: 1 REF: Page: 330 KEY: Cognitive Level: Analysis | Integrated Process: Nursing Process: Diagnosis

A married, 26-year-old client works as a schoolteacher. She and her husband have just had their first child. A nurse should recognize that this client is successfully accomplishing which stage of Erikson's developmental theory? A. Industry versus inferiority B. Identity versus role confusion C. Intimacy versus isolation D. Generativity versus stagnation

ANS: C The nurse should recognize that a 26-year-old client who is married and has a child has successfully accomplished the intimacy versus isolation stage of Erikson's developmental theory. The intimacy versus isolation stage of young adulthood involves forming lasting relationships. Achievement of this task results in the capacity for mutual love and respect. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A jilted college student is admitted to a hospital following a suicide attempt and states, "No one will ever love a loser like me." According to Erikson's theory of personality development, a nurse should recognize a deficit in which developmental stage?A. Trust versus mistrust B. Initiative versus guilt C. Intimacy versus isolation D. Ego integrity versus despair

ANS: C The nurse should recognize that the client who states, "No one will ever love a loser like me" has not adequately completed the intimacy versus isolation stage of development. The intimacy versus isolation stage is presumed to occur in young adulthood between the ages of 20 and 30 years. The major developmental task in this stage is to establish intense, lasting relationships or commitment to another person, cause, institution, or creative effort. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

When a mother brings her 9-month-old to daycare, the child smiles and reaches for the daycare caregiver. The nurse should recognize that according to Mahler's developmental theory, this child's development is at which phase? A. The autistic phase B. The symbiotic phase C. The differentiation subphase of the separation-individuation phase D. The rapprochement subphase of the separation-individuation phase

ANS: C The nurse should understand that this client is in the differentiation subphase of the separation-individuation phase. This subphase begins with the child's initial physical movements away from the mothering figure. A primary recognition of separateness commences. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

According to Peplau, a nurse who provides an abandoned child with parental guidance and praise following small accomplishments is serving which therapeutic role? A. The role of technical expert B. The role of resource person C. The role of surrogate D. The role of leader

ANS: C The nurse who provides an abandoned child with parental guidance and praise is serving the role of the surrogate according to Peplau's interpersonal theory. A surrogate serves as a substitute for another person—in this case, the child's parent. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A client diagnosed with major depressive disorder with psychotic features hears voices commanding self-harm. The client refuses to commit to developing a plan for safety. What should be the nurse's priority intervention at this time? A. Obtaining an order for locked seclusion until client is no longer suicidal B. Conducting 15-minute checks to ensure safety C. Placing the client on one-to-one observation while monitoring suicidal ideations D. Encouraging client to express feelings related to suicide

ANS: C The nurse's priority intervention when a client hears voices commanding self-harm is to place the client on one-to-one observation while continuing to monitor suicidal ideation. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment: Management of Care

A nurse discovers a client's suicide note that details the time, place, and means to commit suicide. What should be the priority nursing intervention and the rationale for this action? A. Administering lorazepam (Ativan) prn, because the client is angry about the discovery of the note B. Establishing room restrictions, because the client's threat is an attempt to manipulate the staff C. Placing this client on one-to-one suicide precautions, because the more specific the plan, the more likely the client will attempt suicide D. Calling an emergency treatment team meeting, because the client's threat must be addressed

ANS: C The priority nursing action should be to place this client on one-to-one suicide precautions, because the more specific the plan, the more likely the client will attempt suicide. The appropriate nursing diagnosis for this client would be risk for suicide. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment: Management of Care

A client is diagnosed with schizophrenia. A physician orders haloperidol (Haldol) 50 mg bid, benztropine (Cogentin) 1 mg prn, and zolpidem (Ambien) 10 mg HS. Which client behavior would warrant the nurse to administer benztropine? A. Tactile hallucinations B. Tardive dyskinesia C. Restlessness and muscle rigidity D. Reports of hearing disturbing voices

ANS: C The symptom of tactile hallucinations and reports of hearing disturbing voices would be addressed by an antipsychotic medication such as haloperidol. Tardive dyskinesia, a potentially irreversible condition, would warrant the discontinuation of an antipsychotic medication such as haloperidol. An anticholinergic medication such as benztropine would be used to treat the extrapyramidal symptoms of restlessness and muscle rigidity. PTS: 1 REF: Page: 346 KEY: Cognitive Level: Comprehension | Integrated Process: Nursing Process: Implementation

While trying to control aggressive behavior, a client asks an assertiveness training nurse to give an example of an "I statement." Which of the following statements is the best example of this assertive communication technique? A. "I would like to know why you came home late without calling me." B. "I hate it when you think you can just come home late without calling anyone to let them know where you are." C. "I feel angry when you come home late without calling." D. "I think you don't care about me, because if you did, you'd call me if you were planning on coming home late."

ANS: C This response clearly states feelings about a situation without blaming another. KEY: Cognitive Level: Application | Integrated Processes: Implementation | Client Need: Psychosocial Integrity

The dean of nursing criticizes a faculty member about views on academic freedom. The faculty member states, "Are you upset because I believe in academic freedom or because you don't?" The faculty member is using which technique to promote assertive behavior? A. Standing up for one's basic human rights B. Delaying assertively C. Inquiring assertively D. Responding assertively with irony

ANS: C This response reflects the use of inquiring assertively. Inquiring assertively is an attempt to seek additional information about critical statements. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A client experienced bradycardia during electroconvulsive therapy (ECT). A nurse assigns a nursing diagnosis of decreased cardiac output R/T vagal stimulation occurring during ECT. Which outcome would the nurse expect the client to achieve? A. The client will verbalize an understanding of the need for moving slowly after treatment. B. The client will maintain an oxygen saturation level of 88% 1 hour after treatment. C. The client will continue adequate tissue perfusion 1 hour after treatment. D. The client will verbalize an understanding of common side effects of ECT.

ANS: C Vagal stimulation induced by ECT may cause a client to experience bradycardia. Adequate tissue perfusion would be a realistic expectation when normal cardiac output is restored. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Planning | Client Need: Physiological Integrity

A client is in therapy with a nurse practitioner for the treatment of arachnophobia. The nurse practitioner decides to use the technique of "flooding." Which intervention best exemplifies this technique? A. Giving rewards for demonstrating a decrease in fear of spiders B. Encouraging the client to sit through the movie "Spiderman" C. Accompanying the client to a 1-hour visit to the local zoo's spider room D. Offering a computer program that progressively presents anxiety-producing spider scenarios

ANS: C Visiting the spider room would flood the client with the phobic stimuli of real spiders. This would continue until the stimulus no longer creates anxiety. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

19. A client diagnosed with schizophrenia takes an antipsychotic agent daily. Which assessment finding should a nurse address first? A. Respirations of 22 beats/minute B. Weight gain of 8 pounds in 2 months C. Temperature of 104°F (40°C) D. Excessive salivation

ANS: C When assessing a client diagnosed with schizophrenia who takes an antipsychotic agent daily, the nurse should immediately address a temperature of 104?F (40?C). A temperature this high places the client at risk for febrile seizure and is the most life-threatening finding. PTS: 1 REF: Page: 346 KEY: Cognitive Level: Analysis | Integrated Process: Nursing Process: Assessment

As the client and nurse move from the orientation stage to the working stage of the therapeutic relationship, which is the nurse's most therapeutic statement? A. "I want to assure you that I will maintain your confidentiality." B. "A long-term goal for someone your age would be to develop better job skills." C. "Which identified problems would you like for us to initially address?" D. "I think first we need to focus on your relationship issues."

ANS: C When moving on a continuum from the orientation to working phase of the nurse-client relationship, the client's identified goals are addressed through mutual therapeutic work to promote client behavioral change. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A nurse is evaluating a client's response to stress. What would indicate to the nurse that the client is experiencing a secondary appraisal of the stressful event? A. When the individual judges the event to be benign B. When the individual judges the event to be irrelevant C. When the individual judges the resources and skills needed to deal with the event D. When the individual judges the event to be pleasurable

ANS: C When the individual judges the resources and skills needed to deal with the event, the individual is conducting a secondary appraisal. There are three types of primary appraisals: irrelevant, benign-positive, and stressful. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

A nursing supervisor is scheduling holiday hours. When the supervisor tells the staff nurse that she needs to work Christmas day, the staff nurse calmly states, "I worked last Christmas and will not work this Christmas." When the supervisor says 'But I need you to work," the nurse repeats "I worked last Christmas and will not work this Christmas." This is an example of which assertive behavior technique? A. Shifting from content to process B. Standing up for one's basic rights C. Responding as a broken record D. Defusing

ANS: C "Responding as a broken record" is an assertive behavior technique that consists of persistently repeating in a calm voice what is wanted. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

The client states, "I get into trouble because I respond violently without thinking. That usually gets me into a mess." Which nursing reply would be most therapeutic to address this client's problem? A. "Everybody loses their temper. It's good that you know that about yourself." B. "I'll bet you have some interesting stories to share about overreacting." C. "Let's explore methods to help you stop and think before taking action." D. "It's good that you are showing readiness for behavioral change."

ANS: C Helping the client to find alternative ways to release tension by more appropriate problem-solving behaviors is a therapeutic nursing intervention. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A client diagnosed with paranoid schizophrenia has a history of aggravated assault. A nurse assigns "Risk for other-directed violence" as the client's priority nursing diagnosis. Based on this diagnosis, which would be an appropriate, correctly written outcome for this client? A. The client will not verbalize anger or hit anyone. B. The client will verbalize anger rather than hit others. C. The client will not inflict harm on others during this shift. D. The client will be restrained if verbal or physical abuse is observed during this shift.

ANS: C Preventing injury to others is the appropriate outcome. Outcomes must be client centered, specific, realistic, and measureable and contain a time frame. Answer "A" does not contain a time frame. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Planning | Client Need: Safe and Effective Care Environment

Which initial nursing approach makes limit-setting better accepted by clients who are aggressively acting out? A. Confronting clients with their needs for secondary gains B. Teaching relaxation techniques C. Reflecting back to the client empathy about the client's distress D. Presenting appropriate values that need to be modified

ANS: C Reflecting back to the client empathy about the client's distress promotes a trusting relationship and may prevent the client's anxiety from escalating when limits are set. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A nurse has identified the following nursing diagnosis: "ineffective communication R/T lack of assertiveness skills AEB inability to state needs." Which statement encourages the client to acknowledge the priority of this problem? A. "Are you having thoughts of harming yourself or others?" B. "With whom are you least assertive?" C. "On a scale of 1 to 10, rank the importance of being assertive." D. "When are you available to attend the assertiveness training class?"

ANS: C This nursing statement encourages the client to objectively evaluate the priority of being assertive. It is important in patient-centered care for the client to prioritize his or her goals for treatment. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

Parents decide to try the nurse practitioner's suggestion of time out when their child misbehaves. What teaching should the nurse practitioner provide the parents? A. "Correct your child's behavior by spanking for a specified time period." B. "Ignore the child's negative behavior." C. "Add positive reinforcement for acceptable behavior." D. "Temporarily move your child to an area where behavior is not being reinforced."

ANS: D A time out is an aversive stimulus or punishment during which the client is removed from the environment where the unacceptable behavior is occurring. Usually during a time out, the person is temporarily isolated so there is no reinforcing attention. This discourages a reoccurrence of the undesired behavior. KEY: Cognitive Level: Application | Integrated Processes: Teaching/Learning | Client Need: Health Promotion and Maintenance

According to Peplau, which nursing action demonstrates the nurse's role as a resource person? A. The nurse balances a safe therapeutic environment to increase the client's sense of belonging. B. The nurse holds a group meeting with the clients on the unit to discuss common feelings about mental illness. C. The nurse monitors the administration of medications and watches for signs of "cheeking." D. The nurse explains, in language the client can understand, information related to the client's health care.

ANS: D According to Peplau, a resource person provides specific answers to questions usually formulated with relation to a larger problem. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

Which is the most appropriate nursing reply when a client asks what the goal and benefit are of assertive skills training? A. "It protects the client from others who express aggressive feelings." B. "It gives reliable, expert information so that clients may correct faulty behaviors." C. "It clarifies misperceptions that have caused clients to distort reality." D. "It improves communication skills in order to improve interpersonal relationships."

ANS: D Assertiveness training helps to develop satisfying interpersonal relationships by teaching people how to communicate in a manner to meet their own needs while respecting the rights and needs of others. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Health Promotion and Maintenance

A nursing student is developing a plan of care for a suicidal client. Which documented intervention should the student implement first? A. Communicate therapeutically. B. Observe the client. C. Provide a hazard-free environment. D. Assess suicide risk.

ANS: D Assessment is the first step of the nursing process to gain needed information to determine further appropriate interventions. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment

A distraught, single, first-time mother cries and asks a nurse, "How can I go to work if I can't afford childcare?" What is the nurse's initial action in assisting the client with the problem-solving process? A. Determine the risks and benefits for each alternative. B. Formulate goals for resolution of the problem. C. Evaluate the outcome of the implemented alternative. D. Assess the facts of the situation.

ANS: D Before any other steps can be taken, accurate information about the situation must be gathered and assessed. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

When asked to identify principles that define the term "maladaptive behavior," which nursing student statement indicates that further teaching is needed? A. "Behavior is maladaptive when it is age inappropriate." B. "Behavior is maladaptive when it interferes with adaptive functioning." C. "Behavior is maladaptive when it is identified as inappropriate in the context of one's culture." D. "Behavior is maladaptive when it results in change within an otherwise stable subsystem."

ANS: D Behaviors that result in change within a subsystem, even when it is stable, could be either adaptive or maladaptive behaviors. This statement, therefore, is incorrect. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

The family of a suicidal client is very supportive and requests more facts related to caring for their family member after discharge. Which information should the nurse provide? A. Address only serious suicide threats to avoid the possibility of secondary gain. B. Promote trust by verbalizing a promise to keep suicide attempt information within the family. C. Offer a private environment to provide needed time alone at least once a day. D. Be available to actively listen, support, and accept feelings.

ANS: D Being available to actively listen, support, and accept feelings increases the potential that a client would confide suicidal ideations to family members. KEY: Cognitive Level: Application | Integrated Processes: Teaching/Learning | Client Need: Psychosocial Integrity

A nursing instructor is asking students about diseases of adaptation and when they are likely to occur. Which student response indicates that learning has occurred? A. "When an individual has limited experience dealing with stress" B. "When an individual inherits maladaptive genes" C. "When an individual experiences existing conditions that exacerbate stress" D. "When an individual's physiological and psychological resources have become depleted"

ANS: D During the stage of exhaustion of the general adaptation syndrome, the individual loses the capacity to adapt effectively because physiological and psychological resources have become depleted. This is the time when diseases of adaptation may occur. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Health Promotion and Maintenance

The nurse practitioner plans to use a psychoanalytical framework when treating a client diagnosed with an anxiety disorder. Which would be the focus of this nursing intervention? A. Correcting inappropriate learning patterns B. Changing a dysfunctional social environment C. Exploring the "here and now" with the client and family D. Exploring behaviors and defense mechanisms associated with the superego.

ANS: D Freud identified the superego as the component of the personality that strives for perfection. Violation of the superego's standards generates guilt and anxiety in a person with a strong superego and understanding of these defense mechanisms is identified as important to assisting the client in achieving desired changes or accepting themselves as unique individuals. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

According to psychoanalytic theory, treatment of symptoms should involve which nursing action? A. Modifying client behaviors by manipulating the environment B. Expressing empathy and presenting reality C. Encouraging the client to note cause and effects of actions D. Recognizing and discussing the client's use of ego defense mechanisms

ANS: D From a psychoanalytic perspective, understanding the use of ego defense mechanisms is important in making determinations about maladaptive behaviors, in planning care for clients to assist in creating change, or in helping clients accept themselves as unique individuals. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A nurse administers ordered preoperative glycopyrrolate (Robinul) 30 minutes prior to a client's electroconvulsive therapy (ECT) procedure. What is the rationale for administering this medication? A. Robinul decreases anxiety during the ECT procedure. B. Robinul induces an unconscious state to prevent pain during the ECT procedure. C. Robinul prevents severe muscle contractions during the ECT procedure. D. Robinul decreases secretions to prevent aspiration during the ECT procedure.

ANS: D Glycopyrrolate (Robinul) is the standard preoperative medication given prior to ECT procedures to decrease secretions and prevent aspiration. KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Implementation | Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies

Research undertaken by Miller and Rahe in 1997 demonstrated a correlation between the effects of life change and illness. This research led to the development of the Recent Life Changes Questionnaire (RLCQ). Which principle most limits the effectiveness of this tool? A. Specific illnesses are not identified. B. The numerical values associated with specific life events are randomly assigned C. Stress is viewed as only a physiological response. D. Personal perception of the event is excluded.

ANS: D Individuals differ in response to life events. The RLCQ uses a scale that does not take these differences into consideration. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Health Promotion and Maintenance

A nursing instructor is teaching about suicide. Which student statement indicates that learning has occurred? A. "Suicidal threats and gestures should be considered manipulative and/or attention-seeking." B. "Suicide is the act of a psychotic person." C. "All suicidal individuals are mentally ill." D. "Fifty to eighty percent of all people who kill themselves have a history of a previous attempt."

ANS: D It is a fact that between 50% and 80% of all people who kill themselves have a history of a previous attempt. All other answer choices are myths about suicide. KEY: Cognitive Level: Application | Integrated Processes: Evaluation | Client Need: Safe and Effective Care Environment

A kindergarten rule states that if unacceptable behavior occurs, a child's personalized fish will be moved to the sea grass. Children who behave keep their fish out of the sea grass. The school nurse should identify this intervention as based on which principle of behavior therapy? A. Classical conditioning B. Conditioned response C. Positive reinforcement D. Negative reinforcement

ANS: D Negative reinforcement is increasing the probability that behavior (appropriate classroom behavior) will recur by removal of an undesirable reinforcing stimulus (personalized fish in sea grass). KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

The treatment team is making a discharge decision regarding a previously suicidal client. Which client assessment information should a nurse recognize as contributing to the team's decision? A. No previous admissions for major depressive disorder B. Vital signs stable; no psychosis noted C. Able to comply with medication regimen; able to problem-solve life issues D. Able to participate in a plan for safety; family agrees to constant observation

ANS: D Participation in a plan of safety and constant family observation will decrease the risk for self-harm. All other answer choices are not directly focused on suicide prevention and safety. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment

A nursing instructor is teaching about the application of Peplau's theory to nursing care. Which student statement indicates that learning has occurred? A. "The nurse assumes the role of a parenting figure, instructing the client in good health practices." B. "The nurse is concerned more about psychosocial functioning than physiological functioning." C. "The nurse bases the client care plan on standardized nursing approaches and physician orders." D. "The nurse applies principles of human relations to the problems that arise at all levels of experience."

ANS: D Peplau applied interpersonal theory to nursing practice and, most specifically, to nurse-client relationship development. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

When is self-disclosure by the nurse appropriate in a therapeutic nurse-client relationship? A. When it is judged that the information may benefit the nurse and client B. When the nurse has a duty to warn C. When the nurse feels emotionally indebted toward the client D. When it is judged that the information may benefit the client

ANS: D Self-disclosure on the part of the nurse may be appropriate when it is judged that the information may therapeutically benefit the client. It should never be undertaken for the purpose of meeting the nurse's needs. KEY: Cognitive Level: Knowledge | Integrated Processes: Communication and Documentation | Client Need: Psychosocial Integrity

A school nurse is assessing a female high school student who is overly concerned about her appearance. The client's mother states, "That's not something to be stressed about!" Which is the most appropriate nursing response? A. "Teenagers! They don't know a thing about real stress." B. "Stress occurs only when there is a loss." C. "When you are in poor physical condition, you can't experience psychological well-being." D. "Stress can be psychological. A threat to self-esteem may result in high stress levels."

ANS: D Stress can be physical or psychological in nature. A perceived threat to self-esteem can be as stressful as a physiological change. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

Which assumption is most reflective of a behavioral theory model? A. Mental illness is characterized by structural and biochemical alterations. B. Thought processes influence behaviors. C. All personality development has a social context. D. There is a basic relationship between stimulus and response.

ANS: D That there is a basic relationship between stimulus and response is an assumption of a behavioral theory model. The connection between a stimulus and a response is strengthened or weakened by the consequences of the response. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A physically and emotionally healthy client has just been fired. During a routine office visit he states to a nurse: "Perhaps this was the best thing to happen. Maybe I'll look into pursuing an art degree." How should the nurse characterize the client's appraisal of the job loss stressor? A. Irrelevant B. Harm/loss C. Threatening D. Challenging

ANS: D The client perceives the situation of job loss as a challenge and an opportunity for growth. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

During a one-to-one session with a client, the client states, "Nothing will ever get better," and "Nobody can help me." Which nursing diagnosis is most appropriate for a nurse to assign to this client at this time? A. Powerlessness R/T altered mood AEB client statements B. Risk for injury R/T altered mood AEB client statements C. Risk for suicide R/T altered mood AEB client statements D. Hopelessness R/T altered mood AEB client statements

ANS: D The client's statements indicate the problem of hopelessness. Prior to assigning either risk for injury or risk for suicide, a further evaluation of the client's suicidal ideations and intent would be necessary. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Analysis | Client Need: Psychosocial Integrity

In the role of milieu manager, which activity should the nurse prioritize? A. Setting the schedule for the daily unit activities B. Evaluating clients for medication effectiveness C. Conducting therapeutic group sessions D. Searching newly admitted clients for hazardous objects

ANS: D The milieu manager should search newly admitted clients for hazardous objects. Safety of the client and others is the priority. Nurses are responsible for ensuring that the client's safety and physiological needs are met within the milieu. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Planning | Client Need: Physiological Integrity

Which nursing intervention would be most appropriate when caring for an acutely agitated client diagnosed with paranoid schizophrenia? A. Provide neon lights and soft music. B. Maintain continual eye contact throughout the interview. C. Use therapeutic touch to increase trust and rapport. D. Provide personal space to respect the client's boundaries.

ANS: D The most appropriate nursing intervention is to provide personal space to respect the client's boundaries. Providing personal space may serve to reduce anxiety and thus reduce the client's risk for violence. PTS: 1 REF: Page: 331 KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Implementation

A nurse is assessing a client diagnosed with paranoid schizophrenia. The nurse asks the client, "Do you receive special messages from certain sources, such as the television or radio?" For which potential symptom of this disorder is the nurse assessing? A. Thought insertion B. Paranoid delusions C. Magical thinking D. Delusions of reference

ANS: D The nurse is assessing for the potential symptom of delusions of reference. A client that believes that he or she receives messages through the radio is experiencing delusions of reference. These delusions involve the client referring to events within the environment to him- or herself. PTS: 1 REF: Page: 327 KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Assessment

A physically healthy, 35-year-old single client lives with parents who provide total financial support. According to Erikson's theory, which developmental task should a nurse assist the client to accomplish? A. Establishing the ability to control emotional reactions B. Establishing a strong sense of ethics and character structure C. Establishing and maintaining self-esteem D. Establishing a career, personal relationships, and societal connections

ANS: D The nurse should assist the client in establishing a career, personal relationships, and societal connections. According to Erikson, nonachievement in the generativity versus stagnation stage results in self-absorption, including withdrawal from others and having no capacity for giving of the self to others. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Health Promotion and Maintenance

A 60-year-old client diagnosed with chronic schizophrenia presents in an emergency department (ED) with uncontrollable tongue movements, stiff neck, and difficulty swallowing. Which medical diagnosis and treatment should a nurse anticipate when planning care for this client? A. Neuroleptic malignant syndrome treated by discontinuing antipsychotic medications. B. Agranulocytosis treated by administration of clozapine (Clozaril). C. Extrapyramidal symptoms treated by administration of benztropine (Cogentin). D. Tardive dyskinesia treated by discontinuing antipsychotic medications.

ANS: D The nurse should expect that an ED physician would diagnose the client with tardive dyskinesia and discontinue antipsychotic medication. Tardive dyskinesia is a condition of abnormal involuntary movements of the mouth, tongue, trunk, and extremities that can be a side effect of typical antipsychotic medications. PTS: 1 REF: Page: 346 KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Planning

According to Erikson's developmental theory, when planning care for a 47-year-old client, which developmental task should a nurse identify as appropriate for this client? A. To develop a basic trust in others B. To achieve a sense of self-confidence and recognition from others C. To reflect back on life events to derive pleasure and meaning D. To achieve established life goals and consider the welfare of future generations

ANS: D The nurse should identify that an appropriate developmental task for a 47-year-old client would be to achieve established life goals and consider the welfare of future generations. According to Erikson, the client would be in the generativity versus stagnation stage of development. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Planning | Client Need: Psychosocial Integrity

A 12-year-old girl becomes hysterical every time she strikes out in softball, falls down when roller-skating, or loses when playing games. According to Peplau's interpersonal theory, in which stage of development should the nurse identify a need for improvement? A. "Learning to count on others" B. "Learning to delay satisfaction" C. "Identifying oneself" D. "Developing skills in participation"

ANS: D The nurse should identify that this client needs to improve in the "Developing skills in participation" stage of Peplau's interpersonal theory. Older children in this phase learn the skills of compromise, competition, and cooperation with others. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Health Promotion and Maintenance

During an admission assessment, a nurse assesses that a client, diagnosed with schizophrenia, has allergies to penicillin, prochlorperazine (Compazine), and bee stings. Based on this assessment data, which antipsychotic medication would be contraindicated? A. Haloperidol (Haldol), because it is used only in older patients. B. Clozapine (Clozaril), because it is incompatible with desipramine. C. Risperidone (Risperdal), because it exacerbates symptoms of depression. D. Thioridazine (Mellaril), because of cross-sensitivity among phenothiazines.

ANS: D The nurse should know that thioridazine (Mellaril) would be contraindicated because of cross-sensitivity among phenothiazines. Prochlorperazine (Compazine) and thioridazine (Mellaril) are both classified as phenothiazines. PTS: 1 REF: Page: 343 KEY: Cognitive Level: Knowledge | Integrated Process: Nursing Process: Assessment

On which task should a nurse place priority during the working phase of relationship development? A. Establishing a contract for intervention B. Examining feelings about working with a particular client C. Establishing a plan for continuing aftercare D. Promoting the client's insight and perception of reality

ANS: D The nurse should place priority on promoting the client's insight and perception of reality during the working phase of relationship development. Establishing a contract for intervention would occur in the orientation phase. Examining feelings about working with a client should occur in the preinteraction phase. Establishing a plan for aftercare would occur in the termination phase. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A nurse directs the client interaction and plans for interventions to achieve client goals. According to Peplau's framework for psychodynamic nursing, what therapeutic role is this nurse assuming? A. The role of technical expert B. The role of resource person C. The role of teacher D. The role of leader

ANS: D The nurse who directs client interaction and plans for interventions is assuming the role of leader. According to Peplau, a leader directs the nurse-client interaction and ensures that actions are taken to achieve goals. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

During the planning of care for a suicidal client, which correctly written outcome should be a nurse's first priority? A. The client will not physically harm self. B. The client will express hope for the future by day 3. C. The client will establish a trusting relationship with the nurse. D. The client will remain safe during the hospital stay.

ANS: D The nurse's priority should be that the client will remain safe during the hospital stay. Client safety should always be the nurse's priority. The "A" answer choice is incorrectly written. Correctly written outcomes must be client focused, measurable, and realistic and contain a time frame. Without a time frame, an outcome cannot be correctly evaluated. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Planning | Client Need: Safe and Effective Care Environment

A mother who has learned that her child was killed in a tragic car accident states, "I can't bear to go on with my life." Which nursing statement conveys empathy? A. "This situation is very sad, but time is a great healer." B. "You are sad, but you must be strong for your other children." C. "Once you cry it all out, things will seem so much better." D. "It must be horrible to lose a child; I'll stay with you until your husband arrives."

ANS: D The nurse's response, "It must be horrible to lose a child; I'll stay with you until your husband arrives," conveys empathy to the client. Empathy is the ability to see the situation from the client's point of view. Empathy is considered to be one of the most important characteristics of the therapeutic relationship. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

During a smoking cessation group, the community health nurse explains that in their effort to quit smoking, a reciprocal inhibition approach will be used. The nurse should give the group which example of this technique? A. "Before you can smoke, you must first take a half-hour walk." B. "When you have the urge to smoke, imagine being short of breath." C. "You'll receive $1 for each cigarette not smoked and forfeit $2 for each cigarette smoked." D. "When you have the urge to smoke, hold your breath and then rhythmically breathe."

ANS: D These breathing exercises cannot be done while the client smokes. Therefore, they decrease or eliminate the undesired behavior (smoking) that is incompatible with the desired behavior (smoking cessation). This is an example of the behavior therapy of reciprocal inhibition. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

During an assertiveness training group, a client admits to aggressive behaviors. The client asks for suggestions for how to become more assertive and less aggressive. Which is the most appropriate nursing reply? A. "Several techniques, including meditation and progressive muscle relaxation, appear helpful." B. "There's not much that can be done about aggressive behavior because of biological responses." C. "Certain types of medications have been proven effective in promoting assertive communication." D. "There are several techniques, including 'I statements,' role playing, and thought stopping, that can help promote assertive behaviors and decrease aggressive behaviors."

ANS: D These techniques promote assertive behaviors and would help diminish aggressive responses. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A child always chooses to ask mother over father when seeking special privileges. The father is more apt to disagree than agree with the child's requests, whereas the mother usually consents. The child's choice is the result of which component of operant conditioning? A. Conditioned stimuli B. Unconditioned stimuli C. Aversive stimuli D. Discriminative stimuli

ANS: D This child is able to discriminate between stimuli. This child can predict with assurance that asking mother (not father) will result in a desired response. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

Which best describes a nurse's use of assertive behavior? A. When a nurse attempts to please others and apologizes for awkwardness in a new role B. When a nurse becomes defensive and angry when peers offer suggestions for improvement C. When a nurse has problems making decisions and has a tendency to procrastinate D. When a nurse is open and direct when asked by the nurse manager to complete assignments

ANS: D This is an assertive response. There is clear expression of needs and feelings. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

An instructor is teaching about assertive rights. Which student statement indicates a need for further instruction? A. "The right to be treated with respect is an assertive right." B. "The right to say "no" without feeling guilty is an assertive right." C. "The right to change your mind is an assertive right." D. "The right to always put oneself first is an assertive right."

ANS: D This is not an assertive right. An assertive right is "to consider others as well as yourself." This student statement indicates a need for further instruction. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

A client on an inpatient unit is angry with a peer. During lunch, when the peer is not looking, the client spits into his soup. How would the nurse document this interaction? A. "Client is displaying assertive behaviors." B. "Client is displaying aggressive behaviors." C. "Client is displaying passive behaviors." D. "Client is displaying passive-aggressive behaviors."

ANS: D This response is passive-aggressive. The client's anger is expressed indirectly by spitting in the soup when the peer is not looking. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

After vying for a nurse management position, nurse "A" is chosen over nurse "B." When nurse manager "A" calls for staff meetings, nurse "B" is chronically late or absent. Nurse "B" is exhibiting which type of behavior? A. Passive B. Assertive C. Aggressive D. Passive-aggressive

ANS: D This response is passive-aggressive. The colleague is expressing anger indirectly by being late or absent from the meetings. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

An aggressive nurse manager tells a staff nurse she has no business rallying staff to change the schedule. What would be an example of a technique that the staff nurse could use to stand up for her basic human rights? A. "What is the real reason that you don't want the schedule changed?" B. "Sounds to me like you're threatened by this change." C. "Are you upset because you don't want to redo the schedule?" D. "I have the right to express my opinion about the schedule."

ANS: D This response reflects the use of standing up for one's basic human rights. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A suicidal client says to a nurse, "There's nothing to live for anymore." Which is the most appropriate nursing reply? A. "Why don't you consider doing volunteer work in a homeless shelter?" B. "Let's discuss the negative aspects of your life." C. "Things will look better in the morning." D. "It sounds like you are feeling pretty hopeless."

ANS: D This statement verbalizes the client's implied feelings and allows him or her to validate and explore them. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A nurse is caring for four clients. Which client should the nurse identify as least prone to developing problems with anger and aggression? A. A child raised by a physically abusive parent B. An adult with a history of epilepsy C. A young adult living in the ghetto of an inner city D. An adolescent raised by Scandinavian immigrant parents

ANS: D An adolescent raised by Scandinavian immigrant parents would be least prone to developing problems with anger and aggression as compared with the other clients presented. A history of abuse, epilepsy, overcrowding, and poverty all contribute as predisposing factors to anger and aggression. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A client is served divorce papers while on the inpatient psychiatric unit. When a nurse tells the client the unit telephone cannot be used after hours, the client raises his fists, swears, and spits at the nurse. Which negative coping mechanism has the client exhibited? A. The defense mechanism of projection B. The defense mechanism of reaction formation C. The defense mechanism of sublimation D. The defense mechanism of displacement

ANS: D Anger can lead to aggression when the coping response is displacement. This client has discharged anger against a person (the nurse) unrelated to the true target of the anger (the spouse). KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

After restraints are removed from a client, the staff discusses the incident and establishes guidelines for the client's return to the therapeutic milieu. Which unit procedure is the staff implementing? A. Milieu reenactment B. Treatment planning C. Crisis intervention D. Debriefing

ANS: D Debriefing is an important part of restraint/seclusion. It allows the staff an opportunity to review and learn from the experience and to express feelings generated by the incident. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment: Management of Care

After less restrictive means have been attempted, an order for client restraints has been obtained for a hostile, aggressive 30- year-old client. If client aggression continues, how long will the nurse expect the client to remain in restraints without a physician order renewal? A. 1 hour B. 2 hours C. 3 hours D. 4 hours

ANS: D The Joint Commission (JCAHO) requires that a physician or licensed independent provider (LIP) must reissue a new order for restraints every 4 hours for adults, every 1 hour for clients younger than 9, and every 2 hours for clients 9 to 17 years. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment

A client is experiencing high stress. The client states, "My boss treats me like a doormat and thinks nothing of demanding frequent overtime." Which nursing intervention would be appropriate? A. To incorporate the family support system into the client's plan of care B. To teach thought-reframing techniques C. To encourage the client to seek other employment D. To teach the client how to use "I" statements

ANS: D The ability to use "I" statements is essential in assertive communication. The situation presented indicates that the client needs assertiveness training. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A client diagnosed with brief psychotic disorder is pacing the milieu and occasionally punches the wall. Which should be the initial nursing action? A. Assertively instruct the client to stop punching the wall. B. Encourage the client to write down feelings in a journal. C. With the help of staff, initiate seclusion protocol. D. Ensure adequate physical space between the nurse and the client.

ANS: D To maintain a safe environment, it is important to initially assure that there is adequate physical space between the nurse and the client. Violence can be related to increased contact and decreased defensible space. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment

A nurse is in the working phase of a therapeutic relationship with a client who has methamphetamine use disorder. Which of the following indicates transference behavior? A. The client asks the nurse whether she will go out to dinner with him. B. The client accuses the nurse of telling him what to do just like his ex-girlfriend. C. The client reminds the nurse of a friend who died from a substance overdose. D. The client becomes angry and threatens harm to himself.

B

A nurse is planning group therapy for clients dealing with bereavement. Which of the following should the nurse include in the initial phase? (SATA) A. Encourage the group to work toward goals. B. Define the purpose of the group. C. Discuss termination of the group. D. Identify informal roles of members within the group. E. Establish an expectation of confidentiality within the group. ATI RN Mental Health Nursing Modules Ch. 8 Notes

B, C, E: Working phase: work toward goals, identify informal roles ATI RN Mental Health Nursing Modules Ch. 8 Notes

A nurse is conducting a family therapy session. The adolescent son tells the nurse that he plans ways to make his sister look bad so his parents will think he's the better sibling, which he believes will give him more privileges. The nurse should identify this dysfunctional behavior as which of the following? A. Placation B. Manipulation C. Blaming D. Distraction ATI RN Mental Health Nursing Modules Ch. 8 Notes

B: Placation: the dysfunctional behavior of taking responsibility for problems to keep peace among family members. Manipulation: the dysfunctional behavior of using dishonesty to support an individual agenda. Blaming: the dysfunctional behavior of blaming others to shift focus away from the individual's own inadequacies. Distraction: the dysfunctional behavior of inserting irrelevant information during attempts at problem solving. ATI RN Mental Health Nursing Modules Ch. 8 Notes

A nurse is orienting a new client to a mental health unit. When explaining the unit's community meetings, which of the following statements by the nurse is appropriate? A. "You and a group of other clients will meet to discuss your treatment plans." B. "Community meetings have a specific agenda that is established by staff." C. "You and the other clients will meet with staff to discuss common problems." D. "Community meetings are an excellent opportunity to explore your personal mental health issues."

C

A nurse is talking with a client who is at risk for suicide following the death of his spouse. Which of the following statements by the nurse is appropriate? A. "I feel very sorry for the loneliness you must be experiencing." B. "Suicide is not the appropriate way to cope with loss." C. "Losing someone close to you must be very upsetting." D. "I know how difficult it is to lose a loved one."

C

A charge nurse is discussing the characteristics of a nurse-client relationship with a newly licensed nurse. Which of the following are appropriate to include in the discussion? (Select all that apply.) A. The needs of both participants are met. B. An emotional commitment exists between the participants. C. It is goal-directed. D. Behavioral change is encouraged. E. A termination date is established.

C, D, E

A nurse wants to use democratic leadership with a group whose purpose is to learn appropriate conflict resolution techniques. The nurse is correct in implementing this form of group leadership when she demonstrates which of the following actions? A. Observes group techniques without interfering with the group process. B. Discusses a technique and then directs members to practice the technique. C. Asks for group suggestions of techniques and then supports discussion. D. Suggests techniques and asks group members to reflect on their use. ATI RN Mental Health Nursing Modules Ch. 8 Notes

C: Laissez-faire: allows the group process to progress without any attempt by the leader to control the direction of the group. Autocratic leadership: controls the direction of the group. Democratic leadership: supports group interaction and decision making to solve problems. ATI RN Mental Health Nursing Modules Ch. 8 Notes

A nurse is working with an established group and identifies various member roles. Which of the following should the nurse identify as an individual role? A. A member who praises input from other members. B. A member who follows the direction of other members. C. A member who brags about accomplishments. D. A mbmer who evaluates the group's performance toward a standard. ATI RN Mental Health Nursing Modules Ch. 8 Notes

C: Maintenance role: individual who praises the input of others / is a follower. Task role: individual who evaluates the group's performance. ATI RN Mental Health Nursing Modules Ch. 8 Notes

A nurse is working on an acute mental health unit forms a group to focus on self-management of medications. At each of the meetings, two of the members use the opportunity to discuss their common interest in gambling on sports. This is an example of which of the following? A. Triangulation B. Group process C. Subgroup D. Hidden agenda ATI RN Mental Health Nursing Modules Ch. 8 Notes

D: Triangulation: third party is drawn into a relationship with two members whose relationship is unstable. Group process: the verbal and nonverbal communication that occurs within the group during group sessions. Subgroup: a small number of people within a larger group who function separately from that group. Hidden agenda: when some group members have a different goal than the stated group goals. The hidden agenda is often disruptive to the effective functioning of the group. ATI RN Mental Health Nursing Modules Ch. 8 Notes

Male Staff Nurse: "I think the changes I have proposed for the unit will improve staff relations, not to mention client care. I'm surprised they haven't been thought of before." Female Head Nurse: Thank you for your suggestions. I will study them and talk to you about them later." a. Standing up for one's basic human rights b. Assuming responsibility for own statements c. Responding as a "broken record" d. Agreeing assertively e. Inquiring assertively f. shifting from content process g. Clouding or fogging h. Defusing I. Delaying assertively j. Responding assertively with irony

I. Delaying assertively

You are having company for dinner, and they are due to arrive in 20 minutes. You are about to finish cooking and still have to shower and dress. The doorbell rings and it is a man selling a new product for cleaning windows. Which of the following is an example of an aggressive response? a. "I don't do windows!" and slam the door in his face. b. "I'll take a case," and write him a check. c. "Sure, I'll take three bottles." Then to yourself you think: "I'm calling this company tomorrow and complaining to the manager about their salespeople coming around at dinnertime!" d. "I'm very busy at the moment. I don't wish to purchase any of your product. Thank you."

a. "I don't do windows!" and slam the door in his face.

You're on your way to the laundry room when you encounter a fellow dorm tenant who often asks you to "throw a few of my things in with yours." You view this as an imposition. He asks you where you're going. Which of the following is an example of a passive-aggressive response? a. "I'm on my way to the Celtics game. Where do you think I'm going?" b. "I'm on my way to do some laundry. Do you have anything you want me to wash with mine?" c. "It's none of your damn business!" d. "I'm going to the laundry room. Please don't ask me to do some of yours. I resent being taken advantage of in that way."

a. "I'm on my way to the Celtics game. Where do you think I'm going?"

You have been studying for a nursing exam all afternoon and lost track of time. Your husband expects dinner on the table when he gets home from work. You have not started cooking yet when he walks in the door and shouts, "Why the heck isn't dinner ready?" Which of the following is an example of a passive-aggressive response? a. "I'm sorry. I'll have it done in no time, honey." But then you move very slowly and take a long time to cook the meal. b. "I'm tired from studying all afternoon. Make your own dinner, you bum! I'm tired of being your slave!" c. "I haven't started dinner yet. I'd like some help from you." d. "I'm so sorry. I know you're tired and hungry. It's all my fault. I'm such a terrible wife!"

a. "I'm sorry. I'll have it done in no time, honey." But then you move very slowly and take a long time to cook the meal.

You and your best friend, Jill, have had plans for 6 months to go on vacation together to Hawaii. You have saved your money and have plane tickets to leave in 3 weeks. She has just called you and reported that she is not going. She has a new boyfriend, they are moving in together, and she does not want to leave him. You are very angry with Jill for changing your plans. Which of the following is an example of an assertive response? a. "I'm very disappointed and very angry. I'd like to talk to you about this later. I'll call you." b. "I'm very happy for you, Jill. I think it's wonderful that you and Jack are moving in together." c. You tell Jill that you are very happy for her, but then say to another friend, "Well, that's the end of my friendship with Jill!" d. "What? You can't do that to me! We've had plans! You're acting like a real slut!"

a. "I'm very disappointed and very angry. I'd like to talk to you about this later. I'll call you."

A nurse is caring for a client who is screaming at staff members and other clients. Which of the following is a therapeutic response by the nurse to the client? a. "Stop screaming, and walk with me outside." b. "Why are you so angry and screaming at everyone?" c. "You will not get your way by screaming?" d. "What was going through your mind when you started screaming?"

a. "Stop screaming, and walk with me outside."

A nurse is assessing a client who has major depressive disorder. THe nurse should identify which of the following client statements as an overt comment about suicide? (SATA) a. "my family will be better off if I'm dead." b. "The stress in my life is too much to handle." c. "I wish my life was over." d. "I don't feel like I can ever be happy again." e. If I kill myself then my problems will go away."

a. "my family will be better off if I'm dead." c. "I wish my life was over." e. If I kill myself then my problems will go away."

Tommy says to his friend, "I can't ever talk to my Daddy until after he has read his newspaper." This is an example of which of the following? a. A rigid boundary b. A boundary violation c. An enmeshed boundary d. A flexible boundary

a. A rigid boundary

The nurse hears John, a client with a history of violence, yelling in the dayroom. The nurse observes his increased agitation, clenched fists, and loud, demanding voice. He is challenging and threatening staff and the other clients. The nurse's priority intervention would be to: a. Call for assistance. b. Draw up a syringe of prn haloperidol. c. Ask John if he would like to talk about his anger. d. Tell John if he does not calm down he will have to be restrained.

a. Call for assistance

John, a client with a history of violence, has been hospitalized on the psychiatric unit. He becomes agitated and begins to threaten the staff and other clients. When all other interventions fail, John is placed in restraints in the seclusion room for his and others' protection. Which of the following are interventions for the client in restraints? (Select all that apply.) a. Check temperature and pulse of extremities. b. Document all observations. c. Explain to the client that restraint is his punishment for violent behavior. d. Provide ongoing assessment and observation. e. Withhold food and fluid until client is calm and can be released from restraint

a. Check temperature and pulse of extremities. b. Document all observations. d. Provide ongoing assessment and observation.

A nurse is assisting with the development of protocols to address the increasing number of suicide attempts in the community. WHich of the following interventions should the nurse include as a primary intervention? a. Conducting a suicide risk screening on all new clients b. Creating a support group for family members of clients who completed suicide c. Educating high school teens about suicide prevention d. .Initiating one-on-one observation for a client who has current suicidal ideation e. Teaching a middle-school educators about warning indicators of suicide.

a. Conducting a suicide risk screening on all new clients c. Educating high school teens about suicide prevention

A nurse is assisting with the development of protocols to address the increasing number of suicide attempts in the community. WHich of the following interventions should the nurse include as a primary intervention? (SATA) a. Conducting a suicide risk screening on all new clients b. Creating a support group for family members of clients who completed suicide c. Educating high school teens about suicide prevention d. .Initiating one-on-one observation for a client who has current suicidal ideation e. Teaching a middle-school educators about warning indicators of suicide.

a. Conducting a suicide risk screening on all new clients c. Educating high school teens about suicide prevention

A nurse is assisting with the development of protocols to address the increasing number of suicide attempts in the community. WHich of the following interventions should the nurse include as a primary intervention? (SATA) a. Conducting a suicide risk screening on all new clients b. Creating a support group for family members of clients who completed suicide c. Educating high school teens about suicide prevention d. .Initiating one-on-one observation for a client who has current suicidal ideation e. Teaching middle-school educators about warning indicators of suicide

a. Conducting a suicide risk screening on all new clients c. Educating high school teens about suicide prevention e. Teaching middle-school educators about warning indicators of suicide

Amanda's mobile home was destroyed by a tornado. Amanda received only minor injuries but is experiencing disabling anxiety in the aftermath of the event. What is this type of crisis called? a. Crisis resulting from traumatic stress b. Maturational/developmental crisis c. Dispositional crisis d. Crisis of anticipated life transitions

a. Crisis resulting from traumatic stress

____ 3. Carrie knew when she married Matt that he had a drinking problem, but she believed he would change. Last night, after becoming intoxicated, Matt beat Carrie until she was unconscious. When she regained consciousness, he was gone. She took a taxi to the emergency department of the local hospital. a. Dispositional crisis b. Crisis of anticipated life transition c. Crisis resulting from traumatic stress d. Maturational or developmental crisis e. Crisis reflecting psychopathy f. Psychiatric emergency

a. Dispositional crisis

Which of these procedures is important immediately following an episode of violence on the unit? (Select all that apply.) a. Document all observations and occurrences. b. Conduct a debriefing with staff. c. Discuss what occurred with other clients who witnessed the incident. d. Warn the client that it could happen again if he becomes violent.

a. Document all observations and occurrences. b. Conduct a debriefing with staff. c. Discuss what occurred with other clients who witnessed the incident.

The most appropriate nursing intervention with Jenny (from question 5) would be to: a. Facilitate arrangements for her to start attending Alateen meetings. b. Help her identify the positive things in her life and recognize that her situation could be a lot worse than it is. c. Teach her about the effects of alcohol on the body and that it can be hereditary. d. Refer her to a psychiatrist for private therapy to learn to deal with her home situation

a. Facilitate arrangements for her to start attending Alateen meetings.

A law school graduate failing the bar exam and a 15-year-old high school girl not being selected for the cheerleading squad are examples of which of the following? a. Focal stimuli b. Contextual stimuli c. Residual stimuli d. Spatial stimuli

a. Focal stimuli

The nurse is using nursing process to care for a client who is suicidal. Which of the following nursing actions is a part of the diagnosis step of the nursing process? a. Identifies nursing diagnosis: Risk for suicide b. Notes that client's family reports recent suicide attempt c. Prioritizes the necessity for maintaining a safe environment for the client d. Obtains a short-term contract from the client to seek out staff if feeling suicida

a. Identifies nursing diagnosis: Risk for suicide

One of the goals of therapeutic community is for clients to become more independent and accept self-responsibility. Which of the following approaches by staff best encourages fulfillment of this goal? a. Including client input and decisions into the treatment plan b. Insisting that each client take a turn as "president" of the community meeting c. Making decisions for the client regarding plans for treatment d. Requiring that the client be bathed, dressed, and attend breakfast on time each morning

a. Including client input and decisions into the treatment plan

Which of the following is true about aggression? (Select all that apply.) a. It is goal directed. b. Its aim is to do harm to a person or object. c. It has a requisite of intent. d. It energizes and mobilizes the body for self-defense

a. It is goal directed. b. Its aim is to do harm to a person or object. c. It has a requisite of intent.

Which of the following outcome criteria would be most appropriate for the client described in question 1? a. Kaylee is able to express positive aspects about herself and her life situation. b. Kaylee is able to accept constructive criticism without becoming defensive. c. Kaylee is able to develop positive interpersonal relationships. d. Kaylee is able to accept positive feedback from others.

a. Kaylee is able to express positive aspects about herself and her life situation.

Major Depression a. Major indication for ECT b. The only absolute contraindication for ECT c. Given prior to ECT to decrease secretions and increase heart rate d. Administered prior to, during and following ECT e. Most common cause of mortality associated with ECT f. Administered as a short-acting anesthetic g. Thoughtto be increased by ECT h. Most common side effects of ECT i. Required before treatment can be initiated j. Muscle relaxant given to prevent bone fractures

a. Major indication for ECT

On the milieu unit, duties of the staff psychiatric nurse include which of the following? (Select all that apply.) a. Medication administration b. Client teaching c. Medical diagnosis d. Reality orientation e. Relationship development f. Group therapy

a. Medication administration b. Client teaching d. Reality orientation e. Relationship development

Lashona was sexually abused as a child. She is a client on the milieu unit with a diagnosis of Borderline Personality Disorder. She has refused to talk to anyone. Which of the following therapies might the IDT team choose for Lashona? (Select all that apply.) a. Music therapy b. Art therapy c. Psychodrama d. Electroconvulsive therapy

a. Music therapy b. Art therapy c. Psychodrama

The nurse is using nursing process to care for a client who is suicidal. Which of the following nursing actions is a part of the planning step of the nursing process? a. Prioritizes the necessity for maintaining a safe environment for the client b. Determines if nursing interventions have been appropriate to achieve desired results c. Obtains a short-term contract from the client to seek out staff if feeling suicidal d. Establishes goal of care: Client will not harm self during hospitalization

a. Prioritizes the necessity for maintaining a safe environment for the client

Mr. and Mrs. Smith and their three children (ages 5, 8, and 10) are in therapy with the nurse psychotherapist. Mrs. Smith tells the nurse that their marriage has been "falling apart" since the birth of their youngest child, Tom. She explains that they "did not want a third child, and I became pregnant even after my husband had undergone a vasectomy. We were very angry, the pregnancy was a problematic one, and the child has been difficult since birth. We had problems before he was born, but since Tom was born, things have gone from bad to worse. No one can control him, and he is wrecking our family!" The nurse assesses that which of the following may be occurring in this family? a. Scapegoating b. Triangling c. Disengagement d. Enmeshment

a. Scapegoating

A nurse is engaging in psychoeducation about improving self-esteem with Shelley, who has depression and low self-esteem. Which of the following are important for the nurse to assess? (Select all that apply.) a. Shelley's focal, contextual, and residual stimuli b. Shelley's abilities with regard to establishment of boundaries c. Shelley's age and whether or not she is married d. The nurse's awareness of his or her own ability to establish appropriate boundaries e. Shelley's predominant communication style and her understanding of assertiveness

a. Shelley's focal, contextual, and residual stimuli b. Shelley's abilities with regard to establishment of boundaries d. The nurse's awareness of his or her own ability to establish appropriate boundaries e. Shelley's predominant communication style and her understanding of assertiveness

S.T. is a 15-year-old girl who has just been admitted to the adolescent psychiatric unit with a diagnosis of anorexia nervosa. She is 5 feet 5 inches tall and weighs 82 pounds. She was selected to join the cheerleading squad for the fall but states that she is not as good as the others on the squad. The treatment team has identified the following problems: refusal to eat, occasional purging, refusing to interact with staff and peers, and fear of failure. Which of the following nursing diagnoses would be appropriate for S.T.? (Select all that apply.) a. Social isolation b. Disturbed body image c. Low self-esteem d. Imbalanced nutrition: Less than body requirements

a. Social isolation b. Disturbed body image c. Low self-esteem d. Imbalanced nutrition: Less than body requirements

Woman #1: "How can you be in favor of abortion? Can't you see it is murder? Woman #2: "I have the right to my opinion just as you have." a. Standing up for one's basic human rights b. Assuming responsibility for own statements c. Responding as a "broken record" d. Agreeing assertively e. Inquiring assertively f. shifting from content process g. Clouding or fogging h. Defusing I. Delaying assertively j. Responding assertively with irony

a. Standing up for one's basic human rights

Which of the following are basic assumptions of milieu therapy? (Select all that apply.) a. The client owns his or her own environment. b. Each client owns his or her behavior. c. Peer pressure is a useful and powerful tool. d. Inappropriate behaviors are punished immediately

a. The client owns his or her own environment. b. Each client owns his or her behavior. c. Peer pressure is a useful and powerful tool.

Which of the following describe advantages of electronic health records (EHRs)? (Select all that apply.) a. They reduce redundancy of information. b. They reduce privacy issues. c. They decrease charting time. d. They facilitate communication between disciplines

a. They reduce redundancy of information. c. They decrease charting time. d. They facilitate communication between disciplines

Using the structural approach with a family in therapy, the therapist would: a. Try to change family principles that may be promoting dysfunctional behavior patterns. b. Strive to create change in destructive behavior through improvement in communications and interaction patterns. c. Encourage increase in the differentiation of individual family members. d. Promote change in dysfunctional behavior by encouraging the formation of more diffuse boundaries between family members.

a. Try to change family principles that may be promoting dysfunctional behavior patterns.

A fellow worker often borrows small amounts of money from you with the promise that she will pay you back "tomorrow." She currently owes you $15 and has not yet paid back any that she has borrowed. She asks if she can borrow a couple of dollars for lunch. Which of the following is an example of a nonassertive response? a. "I've decided not to loan you any more money until you pay me back what you already borrowed." b. "I'm so sorry. I only have enough to pay for my own lunch today." c. "Get a life, will you? I'm tired of you sponging off me all the time!" d. "Sure, here's two dollars." Then to the other workers in the office: "Be sure you never lend Cindy any money. She never pays her debts. I'd be sure never to go to lunch with her if I were you!"

b. "I'm so sorry. I only have enough to pay for my own lunch today."

You are in a movie theater that prohibits smoking. The person in the seat next to you just lit a cigarette and the smoke is very irritating. Which of the following is an example of an assertive response? a. You say nothing. b. "Please put your cigarette out. Smoking is prohibited." c. You say nothing but begin to frantically fan the air in front of you and cough loudly and convulsively. d. "Put your cigarette out, you slob! Can't you read the 'no smoking' sign?"

b. "Please put your cigarette out. Smoking is prohibited."

John tells the nurse, "I think lights out at 10 o'clock on a weekend is stupid. We should be able to watch TV until midnight!" Which of the following is the most appropriate response from the nurse on the milieu unit? a. "John, you were told the rules when you were admitted." b. "You may bring it up before the others at the community meeting, John." c. "Some people want to go to bed early, John." d. "You are not the only person on this unit, John. You must think of others besides yourself."

b. "You may bring it up before the others at the community meeting, John."

In the community meeting, which of the following actions is most important for reinforcing the democratic posture of the therapy setting? a. Allowing each person a specific and equal amount of time to talk b. Reviewing group rules and behavioral limits that apply to all clients c. Reading the minutes from yesterday's meeting d. Waiting until all clients are present before initiating the meeting

b. . Reviewing group rules and behavioral limits that apply to all clients

Jessica told Andrea a secret that Eva had told her. This is an example of which of the following? a. Too flexible a boundary b. A boundary violation c. Too rigid a boundary d. An enmeshed boundary

b. A boundary violation

Which of the following assessment data would the nurse consider as risk factors for possible violence in a client? (Select all that apply.) a. A diagnosis of somatization disorder b. A diagnosis of schizophrenia or bipolar disorder c. Substance intoxication d. Argumentative and demanding behavior e. Past history of violence

b. A diagnosis of schizophrenia or bipolar disorder c. Substance intoxication d. Argumentative and demanding behavior e. Past history of violence

Assertive individuals accept negative aspects about themselves and admit when they have made a mistake. What is this technique called? a. To communicate effectively and to be respected by others b. Agreeing assertively c. Thought-stopping techniques d. Ownership; Individuals take ownership for their own feelings rather than suggesting that they are caused by the other person

b. Agreeing assertively

Head Nurse: "I need someone to stay on and work an extra shift." Staff Nurse: "I don't want to work an extra shift tonight." a. Standing up for one's basic human rights b. Assuming responsibility for own statements c. Responding as a "broken record" d. Agreeing assertively e. Inquiring assertively f. shifting from content process g. Clouding or fogging h. Defusing I. Delaying assertively j. Responding assertively with irony

b. Assuming responsibility for own statements

Which of the following activities would be a responsibility of the psychiatric clinical nurse specialist on the IDT team? a. Manages the therapeutic milieu on a 24-hour basis b. Conducts group therapies and provides consultation and education to staff nurses c. Directs a group of clients in acting out a situation that is otherwise too painful for a client to discuss openly d. Locates halfway house and arranges living conditions for client being discharged from the hospital

b. Conducts group therapies and provides consultation and education to staff nurses

Marie, age 56, is the mother of five children. Her youngest child, who had been living at home and attending the local college, recently graduated and accepted a job in another state. Marie has never worked outside the home and has devoted her life to satisfying the needs of her husband and children. Since the departure of her last child from home, Marie has become increasingly despondent. Her husband has become very concerned and takes her to the local mental health center. What is this type of crisis called? a. Dispositional crisis b. Crisis of anticipated life transitions c. Psychiatric emergency d. Crisis resulting from traumatic stress

b. Crisis of anticipated life transition

____2. Ted was transferred on his job to a distant city. His wife, Jane, had never lived away from her family before. She became despondent, living only for daily phone calls to her relatives back in their hometown. a. Dispositional crisis b. Crisis of anticipated life transition c. Crisis resulting from traumatic stress d. Maturational or developmental crisis e. Crisis reflecting psychopathy f. Psychiatric emergency

b. Crisis of anticipated life transition

A nurse is assessing a client in an inpatient mental health unit. Which of the following findings should the nurse expect if the client is in the preassaultive stage of violence? (SATA). a. Lethargy b. Defensive responses to questions c. Disorientation d. Facial grimacing e. Agitation

b. Defensive responses to questions d. Facial grimacing e. Agitation

The nurse is using nursing process to care for a client who is suicidal. Which of the following nursing actions is a part of the evaluation step of the nursing process? a. Prioritizes the necessity for maintaining a safe environment for the client b. Determines if nursing interventions have been appropriate to achieve desired results c. Obtains a short-term contract from the client to seek out staff if feeling suicidal d. Establishes goal of care: Client will not harm self during hospitalization

b. Determines if nursing interventions have been appropriate to achieve desired results

The most appropriate crisis intervention with Amanda (from question 3) would be to: a. Encourage her to recognize how lucky she is to be alive. b. Discuss stages of grief and feelings associated with each. c. Identify community resources that can help Amanda. d. Suggest that she find a place to live that provides a storm shelter.

b. Discuss stages of grief and feelings associated with each

Twins Jan and Jean still dress alike even though they are grown and married. This is an example of which of the following? a. Rigid boundary b. Enmeshed boundary c. A boundary violation d. Boundary pliancy

b. Enmeshed boundary

A nurse is caring for a client who states, "I plan to commit suicide." Which of the following assessments should the nurse identify as the priority? a. Clint;s educational and economic background b. Lethality of the method and availability of means c .Quality of the client;s social support d. Client's insight into the reasons for the decision

b. Lethality of the method and availability of means

A nurse is conducting chart reviews of multiple clients at a community mental health facility. Which of the following events is an example of client experiencing a maturational crisis? a. Rape b. Marriage C. Severe physical illness d. job loss

b. Marriage

The nurse psychotherapist is working with the Juarez family in the outpatient mental health clinic. The husband says, "We can't agree on anything! And it seems like every time we disagree on something, it ends up in a screaming match." Which of the following prescriptions by the nurse represents a paradoxical intervention for the Jones family? a. Mr. and Mrs. Juarez must not have a disagreement for one full day. b. Mr. and Mrs. Juarez will yell at each other on Tuesdays and Thursdays from 8 p.m. until 8:10 p.m. c. Mr. and Mrs. Juarez must refrain from yelling at each other until the next counseling session. d. Mr. and Mrs. Juarez must not discuss serious issues until they can do so without yelling at each other

b. Mr. and Mrs. Juarez will yell at each other on Tuesdays and Thursdays from 8 p.m. until 8:10 p.m.

The nurse is using nursing process to care for a client who is suicidal. Which of the following nursing actions is a part of the assessment step of the nursing process? a. Identifies nursing diagnosis: Risk for suicide b. Notes that client's family reports recent suicide attempt c. Prioritizes the necessity of maintaining a safe client environment d. Obtains a short-term contract from the client to seek out staff if feeling suicidal

b. Notes that client's family reports recent suicide attempt

A nurse is caring for a client who is experiencing a crisis. Which of the following medications might the provider prescribe? (SATA). a. Lithium carbonate b. Paroxetine c. Risperidone d. Haloperidol e. Lorazepam

b. Paroxetine

A nurse is caring for a client who is speaking in a loud voice with clenched fists. Which of the following actions should the nurse take? a. Insist that the client stop yelling. b. Request that other staff members remain close by. c. Move as close to the client as possible. d. Walk away from the client.

b. Request that other staff members remain close by.

Kaylee, age 26, graduated from law school with a 3.2/4.0 grade point average. She recently took the bar exam and did not pass. Because of this, she had to give up her job at a law firm. She became very depressed and sought counseling at the mental health clinic. During the intake assessment, Kaylee says to the psychiatric nurse, "I am a complete failure. I'm so dumb, I can't do anything right." What is the most appropriate nursing diagnosis for Kaylee? a. Chronic low self-esteem b. Situational low self-esteem c. Defensive coping d. Risk for situational low self-esteem

b. Situational low self-esteem

Using the strategic approach with a family in therapy, the therapist would: a. Try to change family principles that may be promoting dysfunctional behavior patterns. b. Strive to create change in destructive behavior through improvement in communication and interaction patterns. c. Encourage increase in the differentiation of individual family members. d. Promote change in dysfunctional behavior by encouraging the formation of more diffuse boundaries between family members.

b. Strive to create change in destructive behavior through improvement in communication and interaction patterns.

John, age 27, was brought to the emergency department by two police officers. He smelled strongly of alcohol and was combative. His blood alcohol level was measured at 293 mg/dL. His girlfriend reports that he drinks excessively every day and is verbally and physically abusive. The nurses give John the nursing diagnosis of Risk for other-directed violence. What would be appropriate outcome objectives for this diagnosis? (Select all that apply.) a. The client will not verbalize anger or hit anyone. b. The client will verbalize anger rather than hit others. c. The client will not harm self or others. d. The client will be restrained if he becomes verbally or physically abusive

b. The client will verbalize anger rather than hit others. c. The client will not harm self or others.

Increased intracranial pressure a. Major indication for ECT b. The only absolute contraindication for ECT c. Given prior to ECT to decrease secretions and increase heart rate d. Administered prior to, during and following ECT e. Most common cause of mortality associated with ECT f. Administered as a short-acting anesthetic g. Thoughtto be increased by ECT h. Most common side effects of ECT i. Required before treatment can be initiated j. Muscle relaxant given to prevent bone fractures

b. The only absolute contraindication for ECT

The nurse-therapist is counseling the Smith family: Mr. and Mrs. Smith, 10-year-old Rob, and 8-year-old Lisa. When Mr. and Mrs. Smith start to argue, Rob hits Lisa and Lisa starts to cry. The Smiths then turn their attention to comforting Lisa and scolding Rob, complaining that he is "out of control and we don't know what to do about his behavior." These dynamics are an example of which of the following? a. Double-bind messages b. Triangulation c. Pseudohostility d. Multigenerational transmission

b. Triangulation

John and his girlfriend had an argument during her visit. Which behavior by John would indicate he is learning to adaptively problem-solve his frustrations? a. John says to the nurse, "Give me some of that medication before I end up in restraints!" b. When his girlfriend leaves, John goes to the exercise room and punches on the punching bag. c. John says to the nurse, "I guess I'm going to have to dump that broad!" d. John says to his girlfriend, "You'd better leave before I do something I'm sorry for."

b. When his girlfriend leaves, John goes to the exercise room and punches on the punching bag

John and his girlfriend had an argument during her visit. Which behavior by John would indicate he is learning to adaptively problem-solve his frustrations? a. John says to the nurse, "Give me some of that medication before I end up in restraints!" b. When his girlfriend leaves, John goes to the exercise room and punches on the punching bag. c. John says to the nurse, "I guess I'm going to have to dump that broad!" d. John says to his girlfriend, "You'd better leave before I do something I'm sorry for."

b. When his girlfriend leaves, John goes to the exercise room and punches on the punching in restraints!"

The most appropriate nursing intervention with Ginger (from question 7) would be to: a. Suggest she move to a college closer to home. b. Work with Ginger on unresolved dependency issues. c. Help her find someone in the college town from whom she could seek assistance rather than calling her mother regularly. d. Recommend that the college physician prescribe an antianxiety medication for Ginger.

b. Work with Ginger on unresolved dependency issues.

At a hospital committee meeting, a fellow nurse who is the chairperson has interrupted you each time you have tried to make a statement. The next time it happens, you intend to respond assertively. Which of the following is an example of an assertive response? a. "You make a lousy leader! You won't even let me finish what I'm trying to say!" b. You say nothing. c. "Excuse me. I would like to finish my statement." d. You say nothing, but you fail to complete your assignment and do not show up for the next meeting.

c. "Excuse me. I would like to finish my statement."

A client who has been in restraints is now calm. He apologizes to the nurse and says, "I hope I didn't hurt anyone." The nurse's best response is: a. "This is our job. We know how to handle violent clients." b. "We understand you were out of control and didn't really mean to hurt anyone." c. "It is fortunate that no one was hurt. You will not be placed in restraints as long as you can control your behavior." d. "It is an unpleasant situation to have to restrain someone, but we have to think of the other clients. We can't have you causing injury to others. I just hope it won't happen again."

c. "It is fortunate that no one was hurt. You will not be placed in restraints as long as you can control your behavior."

A nurse is conducting group therapy with a group of clients. Which of the following statements made by a client is an example of aggressive communication? a. "I wish you would not make me angry." b. "I feel angry when you leave me." c. "It makes me angry when you interrupt me." d. "You'd better listen to me."

c. "It makes me angry when you interrupt me."

Your husband says, "You're crazy to think about going to college! You're not smart enough to handle the studies and the housework, too." Which of the following is an example of a nonassertive response? a. "I will do what I can and the best that I can." b. (Thinking to yourself): "We'll see how he likes cooking dinner for a change." c. "You're probably right. Maybe I should reconsider." d. "I'm going to do what I want to do, when I want to do it, and you can't stop me!"

c. "You're probably right. Maybe I should reconsider."

A typewritten report for your psychiatric nursing class is due tomorrow at 8 a.m. The assignment was made 4 weeks ago, and yours is ready to turn in. Your roommate says, "I finally finished writing my report, but now I have to go to work, and I don't have time to type it. Please be a dear and type it for me. Otherwise, I'll fail!" You have a date with your boyfriend. Which of the following is an example of an aggressive response? a. "Okay, I'll call Ken and cancel our date." b. "I don't want to stay here and type your report. I'm going out with Ken." c. "You've got to be kidding! What kind of a fool do you take me for, anyway?" d. "Okay, I'll do it." However, when your roommate returns from work at midnight, you are asleep and the report has not been typed.

c. "You've got to be kidding! What kind of a fool do you take me for, anyway?"

Which of the following is a correct assumption regarding the concept of crisis? a. Crises occur only in individuals with psychopathology. b. The stressful event that precipitates crisis is seldom identifiable. c. A crisis situation contains the potential for psychological growth or deterioration. d. Crises are chronic situations that recur many times during an individual's life.

c. A crisis situation contains the potential for psychological growth or deterioration.

Which of the following activities would be a responsibility of the clinical psychologist member of the IDT? a. Locates halfway house and arranges living conditions for client being discharged from the hospital b. Manages the therapeutic milieu on a 24-hour basis c. Administers and evaluates psychological tests that assist in diagnosis d. Conducts psychotherapy and administers electroconvulsive therapy treatments

c. Administers and evaluates psychological tests that assist in diagnosis

In prioritizing care within the therapeutic environment, which of the following nursing interventions would receive the highest priority? a. Ensuring that the physical facilities are conducive to achievement of the goals of therapy b. Scheduling a community meeting for 8:30 each morning c. Attending to the nutritional and comfort needs of all clients d. Establishing contacts with community resources

c. Attending to the nutritional and comfort needs of all clients

The nurse is using nursing process to care for a client who is suicidal. Which of the following nursing actions is a part of the implementation step of the nursing process? a. Prioritizes the necessity for maintaining a safe environment for the client b. Determines if nursing interventions have been appropriate to achieve desired results c. Collaborates with the client to develop a plan for ongoing safety and suicide prevention d. Establishes goal of care: Client will not harm self during hospitalization

c. Collaborates with the client to develop a plan for ongoing safety and suicide prevention

____ 6. Frank was proud of his home. He had saved for many years and built it himself virtually from the ground up. Last night, while he and his wife were visiting in a nearby town, a tornado ripped through his neighborhood and totally destroyed the home. Frank is devastated and for more than a week has sat and stared into space, barely eating and rarely speaking. a. Dispositional crisis b. Crisis of anticipated life transition c. Crisis resulting from traumatic stress d. Maturational or developmental crisis e. Crisis reflecting psychopathy f. Psychiatric emergency

c. Crisis resulting from traumatic stress

Jenny reported to the high school nurse that her mother drinks too much. She is drunk every afternoon when Jenny gets home from school. Jenny is afraid to invite friends over because of her mother's behavior. What is this type of crisis called? a. Crisis resulting from traumatic stress b. Maturational/developmental crisis c. Dispositional crisis d. Crisis reflecting psychopathology

c. Dispositional crisis

Using Bowen's systems approach with a family in therapy, the therapist would: a. Try to change family principles that may be promoting dysfunctional behavior patterns. b. Strive to create change in destructive behavior through improvement in communication and interaction patterns. c. Encourage increase in the differentiation of individual family members. d. Promote change in dysfunctional behavior by encouraging the formation of more diffuse boundaries between family members.

c. Encourage increase in the differentiation of individual family members.

The husband says to his wife, "What do you want to do tonight?" and his wife responds, "Whatever you want to do." This is an example of which of the following? a. Extremely rigid boundaries b. A boundary violation c. Extremely flexible boundaries d. Showing respect for the boundary of another

c. Extremely flexible boundaries

Atropine sulfate a. Major indication for ECT b. The only absolute contraindication for ECT c. Given prior to ECT to decrease secretions and increase hear trate d. Administered prior to, during and following ECT e. Most common cause of mortality associated with ECT f. Administered as a short-acting anesthetic g. Thoughtto be increased by ECT h. Most common side effects of ECT i. Required before treatment can be initiated j. Muscle relaxant given to prevent bone fractures

c. Given prior to ECT to decrease secretions and increase heart rate

John, who was hospitalized with alcohol intoxication and violent behavior, is sitting in the dayroom watching TV with the other clients when the nurse approaches with his 5 p.m. dose of haloperidol. John says, "I feel in control now. I don't need any drugs." The nurse's best response is based on which of the following statements? a. John must have the medication, or he will become violent. b. John knows that if he will not take the medication orally, he will be restrained and given an intramuscular injection. c. John has the right to refuse the medication provided there is no immediate danger to self or others. d. John must take the medication at this time in order to maintain adequate blood levels.

c. John has the right to refuse the medication provided there is no immediate danger to self or others.

Nursing diagnoses are prioritized according to which of the following? a. Degree of potential for resolution b. Legal implications associated with nursing intervention c. Life-threatening potential d. Client and family requests

c. Life-threatening potential

Mr. and Mrs. Jones have been married for 21 years. Mr. Jones is the family breadwinner, and Mrs. Jones has never worked outside the home. Mr. Jones has always made all the decisions for the family, and Mrs. Jones has always been compliant. According to the strategic model of family therapy, this is an example of which of the following? a. Marital schism b. Pseudomutuality c. Marital skew d. Pseudohostility

c. Marital skew

A nurse is caring for a client in an inpatient mental health facility who gets up from a chair and throws it across the day room. Which of the following is the priority nursing action? a. Encourage the client to express her feelings. b. Maintain eye contact with the client. c. Move the client away from others. d. Tell the client that the behavior is not acceptable.

c. Move the client away from others.

Door-to-Door Salesman: "I'd like to demonstrate this steam cleaner by cleaning one of your rugs for you." Housewife: "I'm not interested in seeing a demonstration of a steam cleaner." Door-to-Door Salesman: "But surely you have a rug you'd like to have cleaned!" a. Standing up for one's basic human rights b. Assuming responsibility for own statements c. Responding as a "broken record" d. Agreeing assertively e. Inquiring assertively f. shifting from content process g. Clouding or fogging h. Defusing I. Delaying assertively j. Responding assertively with irony Housewife: "I'm not interested in seeing a demonstration of a steam cleaner."

c. Responding as a "broken record"

Andrew, a New York City firefighter, and his entire unit responded to the terrorist attacks at the World Trade Center. Working as a team, he and his best friend, Carlo, entered the area together. Carlo was killed when the building collapsed. Andrew was injured but survived. Since that time, Andrew has had frequent nightmares and anxiety attacks. He says to the mental health worker, "I don't know why Carlo had to die and I didn't!" This statement by Andrew suggests that he is experiencing: a. Spiritual distress. b. Night terrors. c. Survivor's guilt. d. Suicidal ideation

c. Survivor's guilt.

The intermittent exiting and entering of various family members and reestablishing of the bond of the dyadic marital relationship are characteristics associated with which stage of family development? a. The newly married couple b. The family with adolescents c. The family launching grown children d. The family in later life

c. The family launching grown children

Which of the following is a desired outcome of working with an individual who has witnessed a traumatic event and is now experiencing panic anxiety? a. The individual will experience no anxiety. b. The individual will demonstrate hope for the future. c. The individual will identify that anxiety is at a manageable level. d. The individual will verbalize acceptance of self as worthy.

c. The individual will identify that anxiety is at a manageable level.

The psychiatric nurse encourages Amanda (the client in question 3) to express her anger. Why is this an appropriate nursing intervention? a. Anger is the basis for self-esteem problems. b. The nurse suspects that Amanda was abused as a child. c. The nurse is attempting to guide Amanda through the grief process. d. The nurse recognizes that Amanda has long-standing repressed anger.

c. The nurse is attempting to guide Amanda through the grief process.

What technique may be used to rid the mind of negative thoughts with which an individual may be obsessed? a. To communicate effectively and to be respected by others b. Agreeing assertively c. Thought-stopping techniques d. Ownership; Individuals take ownership for their own feelings rather than suggesting that they are caused by the other person

c. Thought-stopping techniques

When it has been assessed that a client is in control and no longer requires restraining, how does the nurse proceed? a. The nurse removes the restraints. b. The nurse calls for assistance to remove the restraints. c. With assistance, the nurse removes one restraint. d. The nurse tells the client he will have to wait until the doctor comes in.

c. With assistance, the nurse removes one restraint.

You are asked to serve on a committee on which you do not wish to serve. Which of the following is an example of a nonassertive response? a. "Thank you, but I don't wish to be a member of that committee." b. "I'll be happy to serve." But then you don't show up for any of the meetings. c. "I'd rather have my teeth pulled!" d. "Okay, if I'm really needed, I'll serve."

d. "Okay, if I'm really needed, I'll serve."

Client teaching is an important nursing function in milieu therapy. Which of the following statements by the client indicates the need for knowledge and a readiness to learn? a. "Get away from me with that medicine! I'm not sick!" b. "I don't need psychiatric treatment. It's my migraine headaches that I need help with." c. "I've taken Valium every day of my life for the last 20 years. I'll stop when I'm good and ready!" d. "The doctor says I have bipolar disorder. What does that really mean?"

d. "The doctor says I have bipolar disorder. What does that really mean?"

A nurse is conducting a class for a group of newly licensed nurses on caring for clients who are at risk for suicide. Which of the following information should the nurse include in the teaching? a. A client's verbal threat of suicide is attention-seeking behavior b. Interventions are ineffective for clients who really want to commit suicide c. Using the term suicide increases the client's risk for a suicide attempt. d. A no-suicide contract decreases the client's risk for suicide.

d. A no-suicide contract decreases the client's risk for suicide.

Oxygen a. Major indication for ECT b. The only absolute contraindication for ECT c. Given prior to ECT to decrease secretions and increase heart rate d. Administered prior to, during and following ECT e. Most common cause of mortality associated with ECT f. Administered as a short-acting anesthetic g. Thoughtto be increased by ECT h. Most common side effects of ECT i. Required before treatment can be initiated j. Muscle relaxant given to prevent bone fractures

d. Administered prior to, during and following ECT

Wife: You let that guy walk all over you. What a wimp!" Husband: "Yes, I admit I didn't handle that situation very well." a. Standing up for one's basic human rights b. Assuming responsibility for own statements c. Responding as a "broken record" d. Agreeing assertively e. Inquiring assertively f. shifting from content process g. Clouding or fogging h. Defusing I. Delaying assertively j. Responding assertively with irony

d. Agreeing assertively

The most appropriate nursing intervention with Marie (from question 9) would be to: a. Refer her to her family physician for a complete physical examination. b. Suggest she seek outside employment now that her children have left home. c. Identify convenient support systems for times when she is feeling particularly despondent. d. Begin grief work and assist her to recognize areas of self-worth separate and apart from her children.

d. Begin grief work and assist her to recognize areas of self-worth separate and apart from her children

The nurse is using nursing process to care for a client who is suicidal. Which of the following nursing actions is a part of the outcome identification step of the nursing process? a. Prioritizes the necessity for maintaining a safe environment for the client b. Determines if nursing interventions have been appropriate to achieve desired results c. Obtains a short-term contract from the client to seek out staff if feeling suicidal d. Establishes goal of care: Client will not harm self during hospitalization

d. Establishes goal of care: Client will not harm self during hospitalization

Crisis occur when an individual:: a. is exposed to a preceipitating stressor. b. Perceives a stressor to be threatening. c. Has no support system. d. Experiences a stressor and perceives coping strategies to be ineffective

d. Experiences a stressor and perceives coping strategies to be ineffective's life.

Crisis occur when an individual:: a. is exposed to a preceipitating stressor. b. Perceives a stressor to be threatening. c. Has no support system. d. Experiences a stressor and perceives coping strategies to be ineffective

d. Experiences a stressor and perceives coping strategies to be ineffective.

Amanda tried out for the cheerleading squad in junior high but was rejected. At age 15, she had looked forward to trying out for the cheerleading squad in high school. She took cheerleading classes and practiced for many hours every day. However, when tryouts were held, she was not selected. She has become despondent, and her mother takes her to the mental health clinic for counseling. Amanda tells the nurse, "What's the use of trying? I'm not good at anything!" Which of the following nursing interventions is best for Amanda's specific problem? a. Encourage Amanda to talk about her feeling of shame over the second failure. b. Assist Amanda to problem-solve her reasons for not making the team. c. Help Amanda understand the importance of good self-care and personal hygiene in the maintenance of self-esteem. d. Explore with Amanda her past successes and accomplishments.

d. Explore with Amanda her past successes and accomplishments.

S.T. is a 15-year-old girl who has just been admitted to the adolescent psychiatric unit with a diagnosis of anorexia nervosa. She is 5 feet 5 inches tall and weighs 82 pounds. She was selected to join the cheerleading squad for the fall but states that she is not as good as the others on the squad. The treatment team has identified the following problems: refusal to eat, occasional purging, refusing to interact with staff and peers, and fear of failure. Which of the following nursing diagnoses would be the priority diagnosis for S.T.? a. Social isolation b. Disturbed body image c. Low self-esteem d. Imbalanced nutrition: Less than body requirements

d. Imbalanced nutrition: Less than body requirements

Jack and Ann have come to the clinic for family therapy. They have been married for 18 years. Jack had an affair with his secretary 5 years ago. He fired the secretary and assures Ann and the nurse that he has been faithful ever since. Jack tells the nurse, "We have never been able to get along with each other. We can't talk about anything—all we do is shout at each other. And every time she gets angry with me, she brings up my infidelity. I can't even imagine how many times each of us has threatened divorce over the years. Our kids don't have any idea what it is like to have parents who get along with each other. I've really had enough!" The nurse would most likely document which of the following in her assessment of this couple? a. Marital skew b. Pseudohostility c. Double-bind communication d. Marital schism

d. Marital schism

_____ 5. At age 13, Sue was raped by her uncle. The abuse continued for several years. He threatened to kill her mother if she told. Sue is 23 years old now and recently became engaged. She has never had an intimate relationship and experiences panic attacks at the thought of her wedding night. a. Dispositional crisis b. Crisis of anticipated life transition c. Crisis resulting from traumatic stress d. Maturational or developmental crisis e. Crisis reflecting psychopathy f. Psychiatric emergency

d. Maturational or developmental crisis

Ginger, age 19 and an only child, left 3 months ago to attend a college of her choice 500 miles away from her parents. It is Ginger's first time away from home. She has difficulty making decisions and will not undertake anything new without first consulting her mother. They talk on the phone almost every day. Ginger has recently started having anxiety attacks. She consults the nurse practitioner in the student health center. What is this type of crisis called? a. Crisis resulting from traumatic stress b. Dispositional crisis c. Psychiatric emergency d. Maturational/developmental crisis

d. Maturational/developmental crisis

Why are "I" statements effective communication technique? a. To communicate effectively and to be respected by others b. Agreeing assertively c. Thought-stopping techniques d. Ownership; Individuals take ownership for their own feelings rather than suggesting that they are caused by the other person

d. Ownership; Individuals take ownership for their own feelings rather than suggesting that they are caused by the other person

Emma, a nurse in a family medicine outpatient clinic, conducts initial interviews when new families are referred. She has just finished interviewing a mother who has come to the clinic with her three children, ages 5, 7, and 11. The mother says to the oldest child, "You have been such a help to me, playing with your brothers while I talk to the nurse." In assessing family interaction, the nurse recognizes this statement as a direct indicator of which of the following? a. Family climate b. Family members' expectations c. Handling differences d. Self-concept reinforcement

d. Self-concept reinforcement

Karen's counselor asked her if she would like a hug. This is an example of which of the following? a. Rigid boundary b. A boundary violation c. Enmeshed boundary d. Showing respect for the boundary of another

d. Showing respect for the boundary of another

A nurse is caring for a client who is on suicide precautions. WHich of the following interventions should the nurse include in the plan of care? a. Assign the client to a private room. b. Document the client's behavior every hour. c. Allow the client to keep perfume in her room. d. ensure that the client swallows medication.

d. ensure that the client swallows medication.

Intervention with Andrew (from question 15) would include: a. Encouraging expression of feelings. b. Antianxiety medications. c. Participation in a support group. d. a and c. e. All of the above.

e. All of the above.

____ 4. Linda had a history of obssessive-compulsive disorder. SHe was phobic about germs and washed her hands many times every day. Last night, after a party, she had sex with a fellow college student she barely knew. Today, she is extremely anxious and keeps repeating that she knows she has AIDS. Her roomate cannot get her to come out of the shower. a. Dispositional crisis b. Crisis of anticipated life transition c. Crisis resulting from traumatic stress d. Maturational or developmental crisis e. Crisis reflecting psychopathy f. Psychiatric emergency

e. Crisis reflecting psychopathy

Husband: "Boy, I can't believe you screwed up that audition so badly." Wife: "Just what do you think I did that was so wrong?" a. Standing up for one's basic human rights b. Assuming responsibility for own statements c. Responding as a "broken record" d. Agreeing assertively e. Inquiring assertively f. shifting from content process g. Clouding or fogging h. Defusing I. Delaying assertively j. Responding assertively with irony

e. Inquiring assertively

Recent myocardial infarction a. Major indication for ECT b. The only absolute contraindication for ECT c. Given prior to ECT to decrease secretions and increase heart rate d. Administered prior to, during and following ECT e. Most common cause of mortality associated with ECT f. Administered as a short-acting anesthetic g. Thoughtto be increased by ECT h. Most common side effects of ECT i. Required before treatment can be initiated j. Muscle relaxant given to prevent bone fractures

e. Most common cause of mortality associated with ECT

Temporary memory loss and confusion a. Major indication for ECT b. The only absolute contraindication for ECT c. Given prior to ECT to decrease secretions and increase heart rate d. Administered prior to, during and following ECT e. Most common cause of mortality associated with ECT f. Administered as a short-acting anesthetic g. Thoughtto be increased by ECT h. Most common side effects of ECT i. Required before treatment can be initiated j. Muscle relaxant given to prevent bone fractures

f. Administered as a short-acting anesthetic

Thiopental sodium a. Major indication for ECT b. The only absolute contraindication for ECT c. Given prior to ECT to decrease secretions and increase heart rate d. Administered prior to, during and following ECT e. Most common cause of mortality associated with ECT f. Administered as a short-acting anesthetic g. Thoughtto be increased by ECT h. Most common side effects of ECT i. Required before treatment can be initiated j. Muscle relaxant given to prevent bone fractures

f. Administered as a short-acting anesthetic

Match the situation on the left with the type of crisis listed on the right. _____1. Twenty-four-year-old Harriet was informed that her husband was killed in an industrial accident at the plant where he works. An hour later, she was found walking down a busy highway saying, "I'm looking for my lucky rabbit's foot. Everything will be okay if I can just find my lucky rabbit's foot." a. Dispositional crisis b. Crisis of anticipated life transition c. Crisis resulting from traumatic stress d. Maturational or developmental crisis e. Crisis reflecting psychopathy f. Psychiatric emergency

f. Psychiatric emergency

Husband: "Would you please resew this seam? It's coming loose again?" Wife: "I can never do anything to please you!" Husband: "Seems we need to discuss the real issue here!" a. Standing up for one's basic human rights b. Assuming responsibility for own statements c. Responding as a "broken record" d. Agreeing assertively e. Inquiring assertively f. shifting from content process g. Clouding or fogging h. Defusing I. Delaying assertively j. Responding assertively with irony

f. shifting from content process

Husband: "If you'd just slow down, you wouldn't make so many mistakes!" Wife: "You are probably right. It probably would help if I slowed down some." a. Standing up for one's basic human rights b. Assuming responsibility for own statements c. Responding as a "broken record" d. Agreeing assertively e. Inquiring assertively f. shifting from content process g. Clouding or fogging h. Defusing I. Delaying assertively j. Responding assertively with irony

g. Clouding or fogging

Norepinephrine and serotonin a. Major indication for ECT b. The only absolute contraindication for ECT c. Given prior to ECT to decrease secretions and increase heart rate d. Administered prior to, during and following ECT e. Most common cause of mortality associated with ECT f. Administered as a short-acting anesthetic g. Thought to be increased by ECT h. Most common side effects of ECT i. Required before treatment can be initiated j. Muscle relaxant given to prevent bone fractures

g. Thought to be increased by ECT

Male Board Member: "How dare you suggest we hire homosexuals! What kind of company do you think this is?" Female Board Member: "I would like to discuss this further with you when you have had a chance to cool off." a. Standing up for one's basic human rights b. Assuming responsibility for own statements c. Responding as a "broken record" d. Agreeing assertively e. Inquiring assertively f. shifting from content process g. Clouding or fogging h. Defusing I. Delaying assertively j. Responding assertively with irony

h. Defusing

Informed Concent a. Major indication for ECT b. The only absolute contraindication for ECT c. Given prior to ECT to decrease secretions and increase heart rate d. Administered prior to, during and following ECT e. Most common cause of mortality associated with ECT f. Administered as a short-acting anesthetic g. Thoughtto be increased by ECT h. Most common side effects of ECT i. Required before treatment can be initiated j. Muscle relaxant given to prevent bone fractures

i. Required before treatment can be initiated

Succinylcholine a. Major indication for ECT b. The only absolute contraindication for ECT c. Given prior to ECT to decrease secretions and increase heart rate d. Administered prior to, during and following ECT e. Most common cause of mortality associated with ECT f. Administered as a short-acting anesthetic g. Thoughtto be increased by ECT h. Most common side effects of ECT i. Required before treatment can be initiated j. Muscle relaxant given to prevent bone fractures

j. Muscle relaxant given to prevent bone fractures

Man: "If I were your husband, I'd keep my eye on you all the time." Woman: "It's so nice to know you care." a. Standing up for one's basic human rights b. Assuming responsibility for own statements c. Responding as a "broken record" d. Agreeing assertively e. Inquiring assertively f. shifting from content process g. Clouding or fogging h. Defusing I. Delaying assertively j. Responding assertively with irony

j. Responding assertively with irony

Wife: You let that guy walk all over you. What a wimp!" Husband: "Yes, I admit I didn't handle that situation very well." a. Standing up for one's basic human rights b. Assuming responsibility for own statements c. Responding as a "broken record" d. Agreeing assertively e. Inquiring assertively f. shifting from content process g. Clouding or fogging h. Defusing I. Delaying assertively j. Responding assertively with irony

j. Responding assertively with irony

Which is an appropriate initial nursing intervention for a client with chronic low self-esteem? A. Assessing the content of negative self-talk B. Administering anxiolytic medications C. Using reassurance and physical touch D. Using distraction techniques

ANS: A Self-negating verbalizations and internal self-talk undermine self-esteem. Assessing and then intervening to limit or eliminate these negative communications will help improve self-esteem. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

During an inpatient educational group, a client shouts out, "This information is worthless. Nothing you have said can help me." These statements indicate to the nurse leader that the client is assuming which group role? A. The group role of aggressor B. The group role of initiator C. The group role of gatekeeper D. The group role of blocker

ANS: A The nurse should identify that the client is assuming the group role of the aggressor. The aggressor expresses negativism and hostility toward others in the group or to the group leader and may use sarcasm in an effort to degrade the status of others. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

An instructor is teaching nursing students about neurotransmitters. Which term best explains the process of how neurotransmitters released into the synaptic cleft may return to the presynaptic neuron?A. Regeneration B. Reuptake C. Recycling D. Retransmission

ANS: B The nursing instructor should best explain that the process by which neurotransmitters are released into the synaptic cleft and returned to the presynaptic neuron is by reuptake. Reuptake is the process by which neurotransmitters are stored for reuse. KEY: Cognitive Level: Comprehension | Integrated Processes: Teaching/Learning | Client Need: Health Promotion and Maintenance

A client is admitted to an emergency department experiencing memory deficits and decreased motor function. What alteration in brain chemistry should a nurse correlate with the presentation of these symptoms? A. Abnormal levels of serotonin B. Decreased levels of dopamine C. Increased levels of norepinephrine D. Decreased levels of acetylcholine

ANS: D The nurse should correlate memory deficits and decreased motor function with decreased levels of acetylcholine. Acetylcholine is a major effector chemical of the autonomic nervous system. Functions of acetylcholine include sleep regulation, pain perception, the modulation and coordination of movement, and memory. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Physiological Integrity

A 40-year-old female client has never experienced an intimate relationship. A nursing student tells an instructor that this client remains in Erikson's developmental stage of intimacy versus isolation. What is the instructor's most appropriate reply? A. "Erikson's stages of development are assessed by chronological age, not task achievement. This client is in the generativity versus stagnation stage, which occurs from 30 to 65 years of age." B. "Erikson's stages of development are assessed by task achievement, not chronological age. This client is in the intimacy versus isolation stage, which occurs from 20 to 30 years of age." C. "Erikson's stages of development are assessed by task achievement, not chronological age. This client is in the generativity versus stagnation stage, which occurs from 30 to 65 years of age." D. "Erikson's stages of development are assessed by chronological age, not task achievement. This client is in the intimacy versus isolation stage, which occurs from 20 to 30 years of age."

ANS: A Erikson's stages of development are assessed by chronological age, not task achievement. This client is in Erikson's stage of generativity versus stagnation because she is 40 years old. The student has failed to recognize that even though the client did not successfully achieve the intimacy task of the intimacy versus isolation stage, the client must now be assessed at the age-appropriate developmental stage of generativity versus stagnation. KEY: Cognitive Level: Analysis | Integrated Processes: Teaching/Learning | Client Need: Psychosocial Integrity

A client has continual problematic relationships and rejects others before possibly being rejected. The client states, "I am afraid of failing in my job responsibilities." Which correctly written nursing diagnosis should be prioritized for this client? A. Poor self-esteem R/T negative self-image AEB fear of failure B. Altered thought processes R/T anxiety AEB delusions C. Role confusion R/T rejection and poor job productivity D. High risk for violence: self-directed R/T rejection of others

ANS: A Individuals with low self-esteem perceive themselves to be incompetent, unlovable, insecure, and unworthy. A correctly written actual nursing diagnosis must have a related to (R/T) and an evidenced by (AEB) statement. A "risk for" nursing diagnosis does not contain an AEB statement because the problem has not yet occurred. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Analysis | Client Need: Psychosocial Integrity

A nurse is running a group on self-esteem. A client asks, "Where does self-esteem come from?" Which is the most appropriate nursing reply? A. "Many factors, over the life span, influence development and maintenance of self-esteem." B. "Self-esteem is determined by factors outside of an individual's control." C. "Self-esteem is established in childhood and remains relatively fixed throughout life." D. "Genetics are the single largest contributor to an individual's self-esteem."

ANS: A Self-esteem refers to the degree of regard or respect that individuals have for themselves and is a measure of worth that they place on their abilities and judgments. Many factors influence the development of self-esteem over a person's life span. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A clinic nurse is caring for a 40-year-old client who lives with his parents. The client's mother continues to do the client's laundry and provides spending money. Based on this situation, which family dynamic does the nurse recognize? A. Taking over B. Communicating indirectly C. Belittling feelings D. Making assumptions

ANS: A Taking over occurs when a family member fails to allow another member to develop a sense of responsibility and self-worth. By doing the client's laundry and managing finances, the mother is fostering the client's dependence. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

An instructor is teaching about differentiated parent and adult child relationships. Students are instructed to give an example of a well-differentiated parent and adult child relationship. Which student example meets the instructor requirement? A. An adult child considers, but is not governed by, the advice of his or her parents. B. An adult child appears to listen, but ignores, the advice of his or her parents. C. An adult child respects and is governed by the wishes of his or her parents. D. An adult child never requests advice or feedback from his or her parents.

ANS: A The correct student example of a well-differentiated parent and adult child relationship is when an adult child considers, but is not governed by, the advice of his or her parent. The adult child should be differentiated enough not to be threatened by parental advice and should be able to consider the parental advice without feeling the advice must be followed. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

What is the most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a client? A. To clarify personal attitudes, values, and beliefs B. To obtain thorough assessment data C. To determine the client's length of stay D. To establish personal goals for the interaction

ANS: A The most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a client is to clarify personal attitudes, values, and beliefs. Understanding one's own attitudes, values, and beliefs is called self-awareness. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A depressed client states, "I have a chemical imbalance in my brain. I have no control over my behavior. Medications are my only hope to feel normal again." Which nursing response is appropriate? A. "Medications are one way to address chemical imbalances. Environmental and interpersonal factors can also have an impact on biological factors." B. "Because biological factors are the sole cause of depression, medications will improve your mood." C. "Environmental factors have been shown to exert the most influence in the development of depression." D. "Researchers have been unable to demonstrate a link between nature (biology and genetics) and nurture (environment)."

ANS: A The nurse should advise the client that medications are one treatment approach to address biological factors, but there are other factors that affect mood. The nurse should educate the client on environmental and interpersonal factors that can lead to depression and the potential for psychological treatments to have a positive impact on biological factors. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Health Promotion and Maintenance

A 10-week, prenuptial counseling group composed of five couples is terminating. At the last group meeting, a nurse notices that the two most faithful and participative couples are absent. When considering concepts of group development, what might explain this behavior? A. They are experiencing problems with termination, leading to feelings of abandonment. B. They did not think any new material would be covered at the last session. C. They were angry with the leader for not extending the length of the group. D. They were bored with the material covered in the group.

ANS: A The nurse should determine that the clients' absence from the final group meeting may indicate that they are experiencing problems with termination. The termination phase of group development may elicit feelings of abandonment and anger. Successful termination may help members develop skills to cope with future unrelated losses. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A nurse should expect that an increase in dopamine activity might play a significant role in the development of which mental illness? A. Schizophrenia B. Depression C. Body dysmorphic disorder D. Parkinson's disease

ANS: A The nurse should expect that an increase in dopamine activity might play a significant role in the development of schizophrenia. Dopamine functions include regulation of emotions, coordination, and voluntary decision-making ability. Increased dopamine activity is also associated with mania. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Analysis | Client Need: Physiological Integrity

A newly admitted client asks, "Why do we need a unit schedule? I'm not going to these groups. I'm here to get some rest." Which is the most appropriate nursing reply? A. "Group therapy provides the opportunity to learn and practice new coping skills." B. "Group therapy is mandatory. All clients must attend." C. "Group therapy is optional. You can go if you find the topic helpful and interesting." D. "Group therapy is an economical way of providing therapy to many clients concurrently."

ANS: A The nurse should explain to the client that the purpose of group therapy is to learn and practice new coping skills. A basic assumption of milieu therapy is that every interaction, including group therapy, is an opportunity for therapeutic intervention. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

During a community meeting, a nurse encourages clients to present unit problems and discuss possible solutions. Which type of leadership style is the nurse demonstrating? A. Democratic B. Autocratic C. Laissez-faire D. Bureaucratic

ANS: A The nurse who encourages clients to present problems and discuss solutions is demonstrating a democratic leadership style. Democratic leaders share information with group members and promote decision making by the members of the group. The leader provides guidance and expertise as needed. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

During a therapeutic group, two clients engage in an angry verbal exchange. The nurse leader interrupts the exchange and excuses both of the clients from the group. The nurse has demonstrated which leadership style? A. Autocratic B. Democratic C. Laissez-faire D. Bureaucratic

ANS: A The nurse who excuses clients from the group has demonstrated an autocratic leadership style. An autocratic leadership style may be useful in certain situations that require structure and limit-setting. Democratic leaders focus on the members of the group and group-selected goals. Laissez-faire leaders provide no direction to group members. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment: Management of Care

To promote self-reliance, how should a psychiatric nurse best conduct medication administration? A. Encourage clients to request their medications at the appropriate times. B. Refuse to administer medications unless clients request them at the appropriate times. C. Allow the clients to determine appropriate medication times. D. Take medications to the clients' bedside at the appropriate times.

ANS: A The psychiatric nurse promoting self-reliance would encourage clients to request their medications at the appropriate times. Nurses are responsible for the management of medication administration on inpatient psychiatric units; however, nurses must work with clients to foster independence and provide experiences that would foster increased self-esteem. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

In defiance of parental wishes, a Japanese teenager succumbs to peer pressure and gets a tattoo. According to Bowen's family systems theory, how should the community health nurse interpret the teenager's action? A. The teenager is attempting to differentiate self. B. The teenager is triangulating self. C. The teenager is cutting self off emotionally. D. The teenager is exhibiting antisocial traits.

ANS: A The teenager is taking on some of the cultural values of peers and is beginning to develop a unique identity. This process is called differentiation and is a normal task of adolescence. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Analysis | Client Need: Psychosocial Integrity

A couple is in counseling related to their dysfunctional relationship. Their daughter has recently made a suicide gesture. The nurse should recognize that this might be an example of which family system concept? A. Triangulation B. Pseudohostility C. Double-bind communication D. Pseudomutuality

ANS: A Triangulation occurs when a relationship between two people is dysfunctional. A third person is brought into the relationship to help stabilize it. The couple is triangulating with their daughter. The threatened daughter draws attention from her parent's interpersonal conflicts by her own dysfunctional behavior. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Analysis | Client Need: Psychosocial Integrity

During a group discussion, members freely interact with each other. Which member statement is an example of Yalom's curative group factor of imparting information? A. "I found a Web site explaining the different types of brain tumors and their treatment." B. "My brother also had a brain tumor and now is completely cured." C. "I understand your fear and will be by your side during this time." D. "My mother was also diagnosed with cancer of the brain."

ANS: A Yalom's curative group factor of imparting information involves sharing knowledge gained through formal instruction as well as by advice and suggestions given by other group members. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A 47-year-old mother of two has recently undergone a radical mastectomy. She refuses to see anyone and remains isolated and withdrawn. Which of the following may be relevant nursing diagnoses for this client? Select all that apply. A. Disturbed body image B. Situational low self-esteem C. Ineffective coping D. Altered thought processes E. Altered sensory perception

ANS: A, B, C The mastectomy is likely to disturb the client's body image. She is ineffectively coping by withdrawing. She may be experiencing negative feelings about herself related to her altered body image, which would result in low self-esteem. None of the symptoms presented indicate a problem with either altered thought or altered sensory perception. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Analysis | Client Need: Psychosocial Integrity

A nurse is caring for a client who has recently undergone a radical prostatectomy. Which of the following should the nurse recognize as objective symptoms of low self-esteem? Select all that apply. A. Withdrawal from activities B. A decrease in self-care behaviors C. Poor eye contact D. Reports of pain E. Poor posture

ANS: A, B, C, E Withdrawal from activities, a decrease in self-care behaviors, eye contact, and poor posture are all common objective manifestations of low self-esteem. A report of pain should be evaluated as a physical issue before being attributed solely to low self esteem. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

Which of the following observed client behaviors would lead a nurse to evaluate a member as assuming a maintenance group role? Select all that apply. A. A client decreases conflict within the group by encouraging compromise. B. A client offers recognition and acceptance of others. C. A client outlines the task at hand and proposes solutions. D. A client listens attentively to group interaction. E. A client uses the group to gain sympathy from others.

ANS: A, B, D The nurse should identify clients who decrease conflict within the group, offer recognition and acceptance of others, and listen attentively to group interaction as assuming a maintenance group role. There are member roles within each group. Maintenance roles include the compromiser, the encourager, the follower, the gatekeeper, and the harmonizer. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

Which of the following information should a nurse include when explaining causes of anorexia nervosa to a client? Select all that apply. A. There is a possible correlation between abnormal secretion of growth hormone and anorexia nervosa. B. There is a possible correlation between antidiuretic hormone levels and anorexia nervosa. C. There is a possible correlation between low levels of gonadotropin and anorexia nervosa. D. There is a possible correlation between increased levels of prolactin and anorexia nervosa. E. There is a possible correlation between altered levels of oxytocin and anorexia nervosa.

ANS: A, C The nurse should explain to the client that there is a possible correlation between anorexia nervosa and decreased levels of growth hormones and gonadotropin. Anorexia nervosa has also been correlated with increased cortisol levels. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Physiological Integrity

Which of the following symptoms should a nurse expect to assess in a client experiencing elevated levels of thyroid hormone? Select all that apply. A. Emotional lability B. Depression C. Insomnia D. Restlessness E. Apathy

ANS: A, C, D The nurse should assess the client with an elevated level of thyroid hormone for evidence of emotional lability, insomnia, and restlessness. Elevated levels of thyroid hormone indicate a diagnosis of hyperthyroidism or Grave's disease, which is also associated with the symptoms of irritability, anxiety, and weight loss. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Physiological Integrity

Which mental illness should a nurse identify as being associated with a decrease in prolactin hormone level? A. Major depression B. Schizophrenia C. Anorexia nervosa D. Alzheimer's disease

ANS: B Although the exact mechanism is unknown, there may be some correlation between decreased levels of the hormone prolactin and the diagnosis of schizophrenia. Some studies have shown an inverse relationship between prolactin concentrations and symptoms of schizophrenia. KEY: Cognitive Level: Comprehension| Integrated Processes: Nursing Process: Assessment | Client Need: Physiological Integrity

A nursing instructor is teaching about the importance of healthy family-member expectations for newly blended families. Which student statement indicates a need for further instruction? A. "Healthy family-member expectations should be flexible." B. "Healthy family-member expectations should be conforming." C. "Healthy family-member expectations should be individual." D. "Healthy family-member expectations should be realistic."

ANS: B Conforming is a behavior that interferes with adaptive functioning in terms of family member expectations. This student statement indicates a need for further instruction. Realism, flexibility, and individuality are all characteristics of healthy family-member expectations. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

A client shows a nurse a piece of artwork that took 3 days to create. How will this achievement improve the client's self-esteem? A. By providing a framework for assertive behavior B. By providing an expression of feelings and a sense of competence and pride C. By providing a positive perception of body image D. By providing appropriate boundaries for relationship establishment

ANS: B Creating the artwork provides expression of feelings and a sense of competence and pride. This will most likely have a positive effect on the client's self-esteem. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

During family counseling, a husband tells his wife to spend more time with the family, and she responds by stating, "Okay, I'll turn in my resignation tomorrow." The husband replies, "I knew it! You've always been a quitter!" How should the nurse interpret the husband's statement? A. The husband is expressing an emotional cutoff. B. The husband is expressing double-bind communication. C. The husband is expressing indirect messages. D. The husband is expressing avoidance behaviors.

ANS: B Double-bind communication sets up no-win situations. The husband has created a situation in which no matter what the wife does, she is wrong. KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Assessment | Client Need: Psychosocial Integrity

On the basis of Erikson's theory, how should a nurse encourage a 40-year-old client to improve his or her self-esteem? A. Encourage the client to review life goals and accomplishments. B. Encourage the client to volunteer at a school, reading to underprivileged children. C. Encourage the client to form lasting intimate relationships. D. Encourage the client to seek recognition for task achievement.

ANS: B Making meaningful contributions to others is a way to meet the developmental task of the generativity versus stagnation (30 to 65 years) stage of Erikson's developmental theory. This action would promote a 40-year-old client's self-esteem. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

Six months after her husband and children were killed in a car accident, a client is diagnosed with ulcerative colitis. The nurse should recognize that this situation validates which study perspective? A. The study of neuroendocrinology B. The study of psychoimmunology C. The study of diagnostic technology D. The study of neurophysiology

ANS: B Psychoimmunology is the branch of medicine that studies the effects of social and psychological factors on the functioning of the immune system. Studies of the biological response to stress hypothesize that individuals become more susceptible to physical illness following exposure to stressful stimuli. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Physiological Integrity

During a sleep study, a delta rhythm has been recorded for a client experiencing sleep apnea. The nurse recognizes that which characteristic is associated with this rhythm, and what stage of sleep activity would be documented? A. Delta rhythm is a period of dozing, occurring in stage 1 of sleep activity. B. Delta rhythm is a period of deep and restful sleep, occurring in stage 3 of sleep activity. C. Delta rhythm is a period of relaxed waking, occurring in stage 0 of sleep activity. D. Delta rhythm is a period of dreaming, occurring in stage 2 of sleep activity.

ANS: B Stage 3-delta rhythm is a period of deep and restful sleep. Muscles are relaxed, heart rate and blood pressure fall, and breathing slows. No eye movement occurs. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Physiological Integrity

A nursing instructor is teaching about the monoamine category of neurotransmitters. Which student statement indicates that learning about the function of norepinephrine has occurred? A. Norepinephrine functions to regulate movement, coordination, and emotions. B. Norepinephrine functions to regulate mood, cognition, and perception. C. Norepinephrine functions to regulate arousal, libido, and appetite. D. Norepinephrine functions to regulate pain, inflammatory response, and wakefulness.

ANS: B The functions of norepinephrine include the regulation of mood, cognition, perception, locomotion, and cardiovascular function. Norepinephrine has also been implicated in certain mood disorders such as depression and mania, anxiety states, and schizophrenia. KEY: Cognitive Level: Comprehension | Integrated Processes: Teaching/Learning | Client Need: Health Promotion and Maintenance

Which cerebral structure should a nursing instructor describe to students as the "emotional brain"?A. The cerebellum B. The limbic system C. The cortex D. The left temporal lobe

ANS: B The limbic system is often referred to as the "emotional brain." The limbic system is largely responsible for one's emotional state and is associated with feelings, sexuality, and social behavior. KEY: Cognitive Level: Comprehension| Integrated Processes: Nursing Process: Analysis | Client Need: Psychosocial Integrity

A client diagnosed with schizophrenia functions well and is bright, spontaneous, and interactive during hospitalization but then decompensates after discharge. What does the milieu provide that may be missing in the home environment? A. Peer pressure B. Structured programming C. Visitor restrictions D. Mandated activities

ANS: B The milieu, or therapeutic community, provides the client with structured programming that may be missing in the home environment. The therapeutic community provides a structured schedule of activities in which interpersonal interaction and communication with others are emphasized. In the milieu, time is also devoted to personal problems and focus groups. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

During a group session, which client statement demonstrates that the group has progressed to the middle, or working, phase of group development? A. "It's hard for me to tell my story when I'm not sure about the reactions of others." B. "I think Joe's Antabuse suggestion is a good one and might work for me." C. "My situation is very complex, and I need professional, not peer, advice." D. "I am really upset that you expect me to solve my own problems."

ANS: B The nurse should determine that group members have progressed to the working phase of group development when members begin to look to each other instead of to the leader for guidance. Group members in the working phase begin to accept criticism from each other and then use it constructively to foster change. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

During a therapeutic group, a client talks about personal accomplishments in an effort to gain attention. Which group role, assumed by this client, should the nurse identify? A. The task role of gatekeeper B. The individual role of recognition seeker C. The maintenance role of dominator D. The task role of elaborator

ANS: B The nurse should evaluate that the client is assuming the individual role of the recognition seeker. Other individual roles include the aggressor, the blocker, the dominator, the help seeker, the monopolizer, and the seducer. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

A client is admitted to a psychiatric unit with the diagnosis of catatonic schizophrenia. Which of the client's neurotransmitters should a nurse expect to be elevated? A. Serotonin B. Dopamine C. Gamma-aminobutyric acid (GABA) D. Histamine

ANS: B The nurse should expect that elevated dopamine levels might be an attributing factor to the client's current level of functioning. Dopamine functions include regulation of movements and coordination, emotions, and voluntary decision-making ability. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Analysis | Client Need: Physiological Integrity

Which situation should a nurse identify as an example of an autocratic leadership style? A. The president of Sigma Theta Tau assigns members to committees to research problems. B. Without faculty input, the dean mandates that all course content be delivered via the Internet. C. During a community meeting, a nurse listens as clients generate solutions. D. The student nurses' association advertises for candidates for president.

ANS: B The nurse should identify that mandating decisions without consulting the group is considered an autocratic leadership style. Autocratic leadership increases productivity but often reduces morale and motivation due to lack of member input and creativity. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Safe and Effective Care Environment

The nurse should utilize which group function to help an extremely withdrawn, paranoid client increase feelings of security? A. Socialization B. Support C. Empowerment D. Governance

ANS: B The nurse should identify that the group function of support would help an extremely withdrawn, paranoid client increase feelings of security. Support assists group members in gaining a feeling of security from group involvement. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

What is the best rationale for including the client's family in therapy within the inpatient milieu? A. To structure a program of social and work-related activities B. To facilitate discharge from the hospital C. To provide a concrete demonstration of caring D. To encourage the family to model positive behaviors

ANS: B The nurse should include the client's family in therapy within the inpatient milieu to facilitate discharge from the hospital. Family members are invited to participate in some therapy groups and to share meals with the client in the communal dining room. Family involvement may also serve to prevent the client from becoming too dependent on the therapeutic environment. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

Which phase of the nurse-client relationship begins when the individuals first meet and is characterized by an agreement to continue to meet and work on setting client-centered goals? A. Preinteraction B. Orientation C. Working D. Termination

ANS: B The orientation phase is when the individuals first meet and is characterized by an agreement to continue to meet and work on setting client-centered goals. There are four phases of relationship development: preinteraction, orientation, working, and termination. KEY: Cognitive Level: Comprehension | Integrated Process: Nursing Process: Implementation | Client Need: Psychosocial Integrity

What is the priority nursing action during the orientation (introductory) phase of the nurse-client relationship? A. Acknowledge the client's actions and generate alternative behaviors. B. Establish rapport and develop treatment goals. C. Attempt to find alternative placement. D. Explore how thoughts and feelings about this client may adversely impact care.

ANS: B The priority nursing action during the orientation phase of the nurse-client relationship should be to establish rapport and develop treatment goals. Rapport implies feelings on the part of both the nurse and the client based on respect, acceptance, a sense of trust, and a nonjudgmental attitude. It is the essential foundation of the nurse-client relationship. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A man diagnosed with alcohol dependence experiences his first relapse. During his AA meeting, another group member states, "I relapsed three times, but now have been sober for 15 years." Which of Yalom's curative group factors does this illustrate? A. Imparting of information B. Instillation of hope C. Catharsis D. Universality

ANS: B This scenario is an example of the curative group factor of instillation of hope. This occurs when members observe the progress of others in the group with similar problems and begin to believe that personal problems can also be resolved. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

After hearing parents discuss divorce, a 5-year-old develops behavioral problems. Upon dealing with the child's behavioral issues, the marital relationship conflict decreases. The pediatric clinic nurse should recognize that this is an example of which family system concept? A. Differentiation of self B. Triangulation C. Fusion D. Emotional cutoff

ANS: B Triangulation occurs when a relationship between two people is dysfunctional so a third person is brought into the relationship to help stabilize it. The son and his behavioral problems redirect the focus from the couple's marital problems. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

Which of the following behavioral skills should a nurse implement when leading a group that is functioning in the orientation phase of group development? Select all that apply. A. Encouraging members to provide feedback to each other about individual progress B. Ensuring that rules established by the group do not interfere with goal fulfillment C. Working with group members to establish rules that will govern the group D. Emphasizing the need for and importance of confidentiality within the group E. Helping the members to resolve conflicts and foster cohesiveness within the group

ANS: B, C, D During the orientation phase of group development, the nurse leader should work together with members to establish rules that will effectively govern the group. The leader should ensure that group rules do not interfere with goal fulfillment and establish the need for and importance of confidentiality within the group. Members need to establish trust and cohesion to move into the working phase of group development. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment

A nurse attends an interdisciplinary team meeting on an inpatient unit. Which of the following individuals are typically included as members of the interdisciplinary treatment team in psychiatry? Select all that apply. A. Respiratory therapist B. Occupational therapist C. Recreational therapist D. Social worker E. Mental health technician

ANS: B, C, D, E The typical interdisciplinary treatment team in a psychiatric inpatient setting consists of a psychiatrist, psychiatric nurse, psychiatric social worker, music therapist, dietician, psychologist, occupational therapist, recreational therapist, art therapist, mental health technician, and chaplain. Other disciplines may be included on the basis of resources available in a particular hospital setting and individual patient needs. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment

Which of the following are accurate descriptors of a therapeutic community? Select all that apply. A. The unit schedule includes unlimited free time for personal reflection. B. Unit responsibilities are assigned according to client capabilities. C. A flexible schedule is determined by client needs. D. The individual is the sole focus of therapy. E. A democratic form of government exists.

ANS: B, E In a therapeutic community the unit responsibilities are assigned according to client capability, and a democratic form of government exists. Therapeutic communities are structured and provide therapeutic interventions that focus on communication and relationship-development skills. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment

How does a democratic form of self-government in the milieu contribute to client therapy? A. By setting punishments for clients who violate the community rules B. By dealing with inappropriate behaviors as they occur C. By setting community expectations wherein all clients are treated on an equal basis D. By interacting with professional staff members to learn about therapeutic interventions

ANS: C A democratic form of self-government in the milieu contributes to client therapy by setting the expectation that all clients should be treated on an equal basis. Clients participate in the decision-making and problem-solving aspects that affect treatment setting. The norms, rules, and behavioral limits are established by the staff and clients. All individuals have input. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Planning | Client Need: Psychosocial Integrity

A nurse understands that the abnormal secretion of growth hormone may play a role in which illness? A. Acute mania B. Schizophrenia C. Anorexia nervosa D. Alzheimer's disease

ANS: C A nurse should understand that research has found a correlation between abnormal levels of growth hormone and anorexia nervosa. The growth hormone is responsible for growth in children, as well as continued protein synthesis throughout life. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Assessment | Client Need: Physiological Integrity

An experienced psychiatric registered nurse has taken a new position leading groups in a day treatment program. Without further education, which group is this nurse most qualified to lead? A. A psychodrama group B. A psychotherapy group C. A parenting group D. A family therapy group

ANS: C A psychiatric registered nurse is qualified to lead a parenting group. A parenting group can be classified as either a teaching group or therapeutic group. Psychodrama, psychotherapy, and family therapy are forms of group therapy that must be facilitated by qualified leaders who generally have advanced degrees in psychology, social work, nursing, or medicine. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment

A nurse is working in a nursing home. How best can this nurse foster self-esteem in the residents of this facility? A. Allowing them to remain in their rooms as much as they desire to maintain privacy B. Administering anti-anxiety medications as ordered C. Providing a sense of mastery over their environment by giving choices when appropriate D. Teaching assertiveness skills and self-esteem principles

ANS: C A sense of having some power and control over one's life enhances self-esteem. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

Which client statement reflects an understanding of the effect of circadian rhythms on a person's ability to function? A. "When I dream about my mother's horrible train accident, I become hysterical." B. "I get really irritable during my menstrual cycle." C. "I'm a morning person. I get my best work done in the a.m." D. "Every February, I tend to experience periods of sadness."

ANS: C By stating, "I am a morning person," the client demonstrates an understanding that circadian rhythms may influence a variety of regulatory functions, including the sleep-wake cycle, regulation of body temperature, and patterns of activity. Most humans follow a 24-hour cycle that is largely affected by light and darkness. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

During family counseling a child states, "I just want to surf like other kids. Mom says it's okay, but Dad says I'm too young." The mother allows surfing when the father is absent. In the structural model of family therapy, what family interactional pattern should the nurse recognize? A. Multigenerational transmission B. Disengagement C. Mother-child subsystem D. Emotional cutoff

ANS: C In this situation the mother and child have formed a subsystem in which they have aligned themselves against the father. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A father tells his 5-year-old, "Son, today instead of picking flowers in the outfield, let's try to catch a ball." The child subsequently pays attention and catches a ball. Which principle of building self-esteem has the father implemented? A. A sense of competence B. Unconditional love C. Realistic goals D. Reality orientation

ANS: C Low self-esteem can be the result of not being able to achieve established goals. The father has set for the child a realistic goal that the child accomplished. This should promote self-esteem. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

An adolescent, his mother, and his soon-to-be stepfather have been in counseling with the nurse. Which statement by the nurse fosters positive relationships within this new family structure? A. "Stepchildren should be consistently disciplined by only one parent." B. "It is most important to give your full attention to the child's adjustment since it is most difficult for them." C. "Keeping the lines of communication open between everyone in the family is important in establishing healthy relationships." D. "Children need to decide who will be their disciplinarian because this new situation will be stressful."

ANS: C Open lines of communication are needed for newly forming families to begin their relationship together and establish a new family structure. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A home health nurse is visiting an Asian family. A married couple, their three children, and the maternal grandparents all live in the home. How should the nurse interpret the presence of the grandparents in the home? A. The parents have diffuse boundaries and have allowed the grandparental subsystem to be present. B. The grandparental subsystem is not successfully managing separation from the parental subsystem. C. Extended family living arrangements are common in some cultures. D. The nuclear family living arrangement is the preferred environment for childrearing.

ANS: C The Asian culture highly respects the elderly. Having the grandparents living in the home is not uncommon in this culture. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Analysis | Client Need: Psychosocial Integrity

A 30-year-old client diagnosed with depression has been exclusively cared for and financially subsidized by his mother since age 17. According to Erikson's theory, the nurse recognizes that the client has been unsuccessful in meeting which developmental task? A. Trust B. Initiative C. Intimacy D. Ego integrity

ANS: C The client's relationship with his mother has contributed to failing completion of the developmental task of intimacy in Erikson's stage of intimacy versus isolation (20 to 30 years). This has resulted in behaviors such as withdrawal, social isolation, aloneness, and the inability to form lasting relationships, leading to his diagnosis of depression. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Analysis | Client Need: Psychosocial Integrity

During a therapeutic group, which nursing action demonstrates a laissez-faire leadership style? A. The nurse mandates that all group members reveal an embarrassing personal situation. B. The nurse asks for a show of hands to determine group topic preference. C. The nurse sits silently as the group members stray from the assigned topic. D. The nurse shuffles through papers to determine the facility policy on length of group.

ANS: C The nurse leader who sits silently and allows group members to stray from the assigned topic is demonstrating a laissez-faire leadership style. This style allows group members to do as they please with no direction from the leader. Group members often become frustrated and confused in reaction to a laissez-faire leadership style. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment: Management of Care

A nurse believes that the members of a parenting group are in the initial, or orientation, phase of group development. Which group behaviors would support this assumption? A. The group members manage conflict within the group. B. The group members use denial as part of the grief response. C. The group members compliment the leader and compete for the role of recorder. D. The group members initially trust one another and the leader.

ANS: C The nurse should anticipate that members in the initial, or orientation, phase of group development often compliment the leader and compete for the role of recorder. Members in this phase have not yet established trust and have a fear of not being accepted. Power struggles may occur as members compete for their position in the group. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

Which client diagnosis should a nurse associate with a decrease in gamma-aminobutyric acid (GABA)? A. Alzheimer's disease B. Schizophrenia C. Panic disorder D. Depression

ANS: C The nurse should associate a decrease in GABA with panic disorder. Enhancement of the GABA system is the mechanism of action by which benzodiazepines produce a calming effect, thus reducing anxiety. Alterations in the GABA system are also associated with movement disorders and epilepsy. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Analysis | Client Need: Physiological Integrity

A fatherless, 11-year-old African American girl lives with her grandmother after the death of her mother. Her older stepbrother is very involved in her life. How should the community health nurse view this family constellation, and why? A. Abnormal; the grandmother should be concerned with issues other than childrearing. B. Abnormal; a two-parent household is the most advantageous arrangement for parenting. C. Normal; cultural variations exist in the family life cycle. D. Normal; because of their wisdom, older adults make better parenting figures.

ANS: C The nurse should be aware that cultural differences and specific events may lead to variety in family constellations. This is normal. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A client has undergone psychological testing. With which member of the interdisciplinary team should a nurse collaborate to review these results? A. The psychiatrist B. The psychiatric social worker C. The clinical psychologist D. The clinical nurse specialist

ANS: C The nurse should consult with the clinical psychologist to review psychological testing results for the client. Clinical psychologists can administer, interpret, and evaluate psychological tests to assist in the diagnostic process. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment

A nursing instructor is teaching about psychodrama, a specialized type of therapeutic group. Which student statement indicates that further teaching is necessary? A. "Psychodrama provides a safe setting in which to discuss painful issues." B. "In psychodrama, the client is the protagonist." C. "In psychodrama, the client observes actor interactions from the audience." D. "Psychodrama facilitates resolution of interpersonal conflicts."

ANS: C The nurse should educate the student that in psychodrama the client plays the role of himself or herself in a life-situation scenario and is called the protagonist. During psychodrama, the client does not observe interactions from the audience. Other group members perform the role of the audience and discuss the situation they have observed, offer feedback, and express their feelings. Leaders of psychodrama must have specialized training to become a psychodramatist. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

Which client statement should a nurse identify as a typical response to stress most often experienced in the working phase of the nurse-client relationship? A. "I can't bear the thought of leaving here and failing." B. "I might have a hard time working with you. You remind me of my mother." C. "I can't tell my husband how I feel; he wouldn't listen anyway." D. "I'm not sure that I can count on you to protect my confidentiality."

ANS: C The nurse should identify that the client statement "I can't tell my husband how I feel; he wouldn't listen anyway" reflects resistance to change, which is a common behavior in the working phase of the nurse-client relationship. The working phase includes overcoming resistant behaviors on the part of the client as the level of anxiety rises in response to discussion of painful issues. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

When planning group therapy, a nurse should identify which configuration as most optimal for a therapeutic group? A. Open-ended membership; circle of chairs; group size of 5 to 10 members B. Open-ended membership; chairs around a table; group size of 10 to 15 members C. Closed membership; circle of chairs; group size of 5 to 10 members D. Closed membership; chairs around a table; group size of 10 to 15 members

ANS: C The nurse should identify that the most optimal conditions for a therapeutic group are when the membership is closed and the group size is between 5 and 10 members who are arranged in a circle of chairs. The focus of therapeutic groups is on relationships within the group and the interactions among group members. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Planning | Client Need: Safe and Effective Care Environment: Management of Care

Which part of the nervous system should a nurse identify as playing a major role during stressful situations? A. Peripheral nervous system B. Somatic nervous system C. Sympathetic nervous system D. Parasympathetic nervous system

ANS: C The nurse should identify that the sympathetic nervous system plays a major role during stressful situations. The sympathetic nervous system prepares the body for the fight-or-flight response. The parasympathetic nervous system is dominant when an individual is in a nonstressful state. KEY: Cognitive Level: Comprehension | Integrated Processes: Teaching/Learning | Client Need: Health Promotion and Maintenance

A withdrawn client diagnosed with schizophrenia expresses little emotion and refuses to attend group therapy. What altered component of the nervous system should a nurse recognize as being implicated in this behavior? A. Dendrites B. Axons C. Neurotransmitters D. Synapses

ANS: C The nurse should recognize that neurotransmitters play an essential function in the role of human emotion and behavior. Neurotransmitters are targeted and affected by many psychotropic medications. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

What should be the nurse's primary goal during the preinteraction phase of the nurse-client relationship? A. To evaluate goal attainment and ensure therapeutic closure B. To establish trust and formulate a contract for intervention C. To explore self-perceptions D. To promote client change

ANS: C The nurse's primary goal of the preinteraction phase should be to explore self-perceptions. The nurse should be aware of how any preconceptions may affect his or her ability to care for individual clients. Another goal of the preinteraction phase is to obtain available client information. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Planning | Client Need: Psychosocial Integrity

An angry client on an inpatient unit approaches a nurse, stating, "Someone took my lunch! People need to respect others, and you need to do something about this now!" The nurse's response should be guided by which basic assumption of milieu therapy? A. Conflict should be avoided at all costs on inpatient psychiatric units. B. Conflict should be resolved by the nursing staff. C. Every interaction is an opportunity for therapeutic intervention. D. Conflict resolution should be addressed only during group therapy.

ANS: C The nurse's response should be guided by the basic assumption that every interaction is an opportunity for therapeutic intervention. The nurse can utilize milieu therapy to effect behavioral change and improve psychological health and functioning. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A client is angry because her husband has forgotten their anniversary. The following week, the client is still unwilling to discuss this with her husband because she is afraid she will lose control. How should the nurse interpret this client's means of coping with anger? A. Coping by attacking B. Coping by surrendering C. Coping by avoiding D. Coping by belittling

ANS: C When coping by avoidance, differences are never acknowledged openly. The individual who disagrees avoids discussing it for fear that the other person will withdraw love or approval or become angry in response to the disagreement. Avoidance also occurs when an individual fears loss of control of his or her temper. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

A home health nurse visits an 18-year-old client who lives with his mother. The client has been assessed as having low self-esteem. The nurse refers the client for individual counseling. During the next home visit, which assessed client behavior clearly indicates treatment success? A. The client wants to buy a dog but has not yet asked his mother's permission. B. The client asks his mother for permission to buy a dog. C. The client tells his mother he plans to buy a dog. D. The client buys a dog and hides it in the garage.

ANS: C When the client tells his mother he plans to buy a dog, he is making decisions and taking on responsibilities. This indicates an increase in self-confidence and therefore self-esteem. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

The nurse is working with a 15-year-old client suffering from low self-esteem. According to Erikson's psychosocial developmental theory, which factor has most probably influenced this client's self-esteem? A. Regret over life choices B. Lack of personal concern for others C. Inconsistent, overly harsh, or absent parental discipline D. Parental labeling of the child as "good" regardless of their behavior.

ANS: C When there is inconsistent, overly harsh, or absent discipline in the home, it is difficult for a teenager to develop the independent sense of self needed to achieve a positive self-esteem. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A 30-year-old client seeking therapy states, "My mom cries when she is not included in all my social activities and thinks of my friends as her own." How would the nurse describe the boundaries between this family's parent and child subsystems? A. The boundaries are rigid. B. The boundaries are restructured. C. The boundaries are enmeshed. D. The boundaries are disengaged.

ANS: C With enmeshed boundaries, family members lack individuation and experience exaggerated connectedness. The client's mother is trying to prevent independence by generating feelings of guilt. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment |Client Need: Psychosocial Integrity

Prayer group members at a local Baptist church are meeting with a poor, homeless family they are supporting. Which member statement is an example of Yalom's curative group factor of altruism? A. "I'll give you the name of a friend that rents inexpensive rooms." B. "The last time we helped a family, they got back on their feet and prospered." C. "I can give you all of my baby clothes for your little one." D. "I can appreciate your situation. I had to declare bankruptcy last year."

ANS: C Yalom's curative group factor of altruism occurs when group members provide assistance and support to each other, creating a positive self-image and promoting self-growth. Individuals increase self-esteem through mutual caring and concern. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A couple has been married for 20 years. They argue constantly, belittle feelings, and continuously contradict each other. During a therapy session, the nurse documents "Marital schism." What does the nurse mean by this documentation? A. The couple has a compatible marriage relationship. B. The husband has a dominant relationship over the wife. C. The couple has an enmeshed relationship. D. The couple has an incompatible marriage relationship.

ANS: D A marital schism is a state of chronic disequilibrium and discord. This describes this couple's marriage. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A nurse enters an inpatient room and finds the family disagreeing about the client's living arrangements after discharge. Which information should the nurse provide when teaching techniques to resolve family conflicts? A. All family members should use past incidents to make their point. B. One family member should act as a gatekeeper in order to avoid family confrontation. C. One family member should act as a compromiser to preserve harmony in the family system. D. All family members should respect differing opinions and use compromise and negotiation.

ANS: D Functional families allow and respect differences among members. They learn to handle differences and conflict through negotiation and compromise. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Health Promotion and Maintenance

During family counseling a husband states, "Every time my wife and I discuss child discipline, we get into shouting matches." The nurse instructs the couple to shout at each other for 2 weeks on Tuesdays and Thursdays for 30 minutes. What intervention is the nurse using? A. Reframing B. Restructuring the family C. Expressive psychotherapy D. Paradoxical intervention

ANS: D In a paradoxical intervention, the therapist requests the family to continue the maladaptive behavior. This removes control over the behavior from the family to the therapist. Clients are made more aware of the defeating behavior and this can lead to behavioral change. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A student nurse is studying the effect of the drug isocarboxazid (Marplan) on neurobiology. The student should recognize that the neurotransmitter serotonin is catabolized by which enzyme? A. Glycosyltransferase B. Peptidase C. Polymerase D. Monoamine oxidase

ANS: D Serotonin that is not returned to be stored in the axon terminal vesicles is catabolized by the enzyme monoamine oxidase. A monoamine oxidase inhibitor, such as Marplan, inhibits this catabolism, providing more available serotonin at the neuron synapse. KEY: Cognitive Level: Application | Integrated Processes: Teaching/Learning | Client Need: Physiological Integrity

A 40-year-old client lives with her parents. She has a high school diploma and works at a low-paying job. Her parents give her a weekly allowance to supplement her income. How should the nurse classify their client-parent boundaries? A. As loose B. As rigid C. As flexible D. As enmeshed

ANS: D The client and her parents are overly dependent. The parents control too many aspects of the client's life. Their boundaries are blurred so that it is hard for the client to differentiate her wants and needs from those of her parents. The client-parent boundaries are enmeshed. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A depressed 21-year-old client has lived with his mother ever since the death of his father 3 years ago. After the client received a college acceptance, the mother repeatedly states, "That's wonderful. I'll be fine all alone." How would the nurse interpret the mother's statements? A. The mother is withholding supportive messages. B. The mother is expressing denigrating remarks. C. The mother is communicating indirectly. D. The mother is using double-bind communication.

ANS: D The client's mother says she is fine with him going away to college but then tries to make him feel guilty about her being left alone. The client is in a no-win situation because his mother has given a mixed message—a double-bind communication. KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Analysis | Client Need: Psychosocial Integrity

A client on an inpatient unit angrily states to a nurse, "Peter is not cleaning up after himself in the community bathroom. You need to address this problem." Which is the appropriate nursing response? A. "I'll talk to Peter and present your concerns." B. "Why are you overreacting to this issue?" C. "You should bring this to the attention of your treatment team." D. "I can see that you are angry. Let's discuss ways to approach Peter with your concerns."

ANS: D The most appropriate nursing response involves restating the client's feeling and developing a plan with the client to solve the problem. According to Skinner, every interaction in the therapeutic milieu is an opportunity for therapeutic intervention to improve communication and relationship-development skills. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

Which group leader activity should a nurse identify as being most important in the final, or termination, phase of group development? A. The group leader establishes the rules that will govern the group after discharge. B. The group leader encourages members to rely on each other for problem solving. C. The group leader presents and discusses the concept of group termination. D. The group leader helps the members to process feelings of loss.

ANS: D The most effective intervention in the final, or termination, phase of group development would be for the group leader to help the members to process feelings of loss. The leader should encourage the members to review the goals and discuss outcomes, reminisce about what has occurred, and encourage members to provide feedback to each other about progress. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A nurse concludes that a restless, agitated client is manifesting a "fight-or-flight" response. The nurse should associate this response with which neurotransmitter? A. Acetylcholine B. Dopamine C. Serotonin D. Norepinephrine

ANS: D The nurse should associate the neurotransmitter norepinephrine with the "fight-or-flight" response. Norepinephrine produces activity in the sympathetic postsynaptic nerve terminal and is associated with the regulation of mood, cognition, perception, locomotion, sleep, and arousal. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Analysis | Client Need: Physiological Integrity

A client diagnosed with major depressive disorder asks, "What part of my brain controls my emotions?" Which nursing response is appropriate? A. "The occipital lobe governs perceptions, judging them as positive or negative." B. "The parietal lobe has been linked to depression." C. "The medulla regulates key biological and psychological activities." D. "The limbic system is largely responsible for one's emotional state."

ANS: D The nurse should explain to the client that the limbic system is largely responsible for one's emotional state. This system is often called the "emotional brain" and is associated with feelings, sexuality, and social behavior. The occipital lobes are the area of visual reception and interpretation. Somatosensory input (touch, taste, temperature, etc.) occurs in the parietal lobes. The medulla contains vital centers that regulate heart rate and reflexes. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Health Promotion and Maintenance

A nurse working on an inpatient psychiatric unit is assigned to conduct a 45-minute education group. What should the nurse identify as an appropriate group topic? A. Dream analysis B. Creative cooking C. Paint by number D. Stress management

ANS: D The nurse should identify that teaching clients about stress management is an appropriate education group topic. Nurses should be able to perform the role of client teacher in the psychiatric area. Nurses need to be able to assess a client's learning readiness. Other topics for education groups include medical diagnoses, side effects of medications, and the importance of medication compliance. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Planning | Client Need: Psychosocial Integrity

A nurse should recognize that a decrease in norepinephrine levels would play a significant role in which mental illness? A. Mania B. Schizophrenia C. Anxiety D. Depression

ANS: D The nurse should recognize that a decrease in norepinephrine levels would play a significant role in generating the symptoms of depression. The functions of norepinephrine include the regulation of mood, cognition, perception, locomotion, cardiovascular functioning, and sleep and arousal. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Analysis | Client Need: Physiological Integrity

Which is the best nursing action when a client demonstrates transference toward a nurse? A. Promoting safety and immediately terminating the relationship with the client B. Encouraging the client to ignore these thoughts and feelings C. Immediately reassigning the client to another staff member D. Helping the client to clarify the meaning of the current nurse-client relationship

ANS: D The nurse should respond to a client's transference by clarifying the meaning of the nurse-client relationship, based on the current situation. Transference occurs when the client unconsciously displaces feelings toward the nurse about a person from the past. The nurse should assist the client in separating the past from the present. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

During the sixth week of a 10-week parenting skills group, a nurse observes as several members get into a heated dispute about spanking. As a group, they decide to create a pros-and-cons poster on the use of physical discipline. At this time, what is the role of the group leader? A. To referee the debate B. To adamantly oppose physical discipline measures C. To redirect the group to a less controversial topic D. To encourage the group to solve the problem collectively

ANS: D The role of the group leader is to encourage the group to solve the problem collectively. A democratic leadership style supports members in their participation and problem-solving. Members are encouraged to cooperatively solve issues that relate to the group. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A single, pregnant teenager in a parenting class discloses her ambivalence toward the pregnancy and the subsequent guilt that these thoughts generate. A mother of three admits to having felt that way herself. Which of Yalom's curative group factors does this illustrate? A. Imparting of information B. Instillation of hope C. Altruism D. Universality

ANS: D The scenario is an example of the curative group factor of universality. Universality occurs when individuals realize that they are not alone in the problems, thoughts, and feelings they are experiencing. This realization reduces anxiety by the support and understanding of others. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

In what way should a nurse expect a school-aged child to gain positive self-esteem, according to Erikson's psychosocial developmental stages? A. Through basic need fulfillment and environmental predictability B. Through exploration and experimentation, resulting in self-confidence in ability to perform C. Through positive reinforcement of creativity and recognition of performance D. Through receiving recognition when learning, competing, and performing successfully

ANS: D The school-aged child develops self-confidence by learning, competing, and performing successfully and receiving recognition from significant others, peers, and acquaintances. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A nursing instructor is teaching students about self-help groups like Alcoholics Anonymous (AA). Which student statement indicates that learning has occurred? A. "There is little research to support AA's effectiveness." B. "Self-help groups used to be the treatment of choice, but their popularity is waning." C. "These groups have no external regulation, so clients need to be cautious." D. "Members themselves run the group, with leadership usually rotating among the members"

ANS: D The student indicates an understanding of self-help groups when stating, "Members themselves run the group, with leadership usually rotating among the members." Nurses may or may not be involved in self-help groups. These groups allow members to talk about feelings and reduce feelings of isolation, while receiving support from others undergoing similar experiences. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Health Promotion and Maintenance

A client's wife of 34 years dies unexpectedly. The client cries often and becomes socially isolated. The client's therapist stresses the importance of proper sleep, nutrition, and exercise. What is the best rationale for the therapist's advice? A. The therapist is using an interpersonal approach. B. The client has an alteration in neurotransmitters. C. It is routine practice to remind clients about nutrition, exercise, and rest. D. The client is susceptible to illness due to effects of stress on the immune system.

ANS: D The therapist's advice should be based on the knowledge that the client has been exposed to stressful stimuli and is at an increased risk of developing illness due to the effects of stress on the immune system. The study of this branch of medicine is called psychoimmunology. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Physiological Integrity

Which types of adoption studies should a nurse recognize as providing useful information for the psychiatric community? A. Studies in which children with mentally ill biological parents are raised by adoptive parents who were mentally healthy B. Studies in which children with mentally healthy biological parents are raised by adoptive parents who were mentally ill C. Studies in which monozygotic twins from mentally ill parents were raised separately by different adoptive parents D. Studies in which monozygotic twins were raised together by mentally ill biological parents E. All of the above

ANS: E The nurse should determine that all of the studies could possibly benefit the psychiatric community. The studies may reveal research findings relating genetic links to mental illness. Adoption studies allow comparisons to be made of the influences of the environment versus genetics. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Evaluation | Client Need: Health Promotion and Maintenance