CMAN 272 EXAM 1

The nurse wants to assess a family's rational patterns by creating their genogram. Which statement best describes the purpose of such an analysis? "A genogram will assess risk for mental illness in future generations." "A genogram is a tool used for deciding on the best type of therapy for your family." "A genogram will help me see your family structure, history, and current functioning." "A genogram will help us determine the cause of Jeremy's schizophrenia."

"A genogram will help me see your family structure, history, and current functioning." By creating a genogram, nurses and therapists are able to map the family structure and record family information that reflects both history and current functioning. The other options do not describe the function of a genogram.DIF: Cognitive Level: Analyze (Analysis)REF: page 19TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity

When a group member supports and encourages another group member and feels "good" about doing so, which group phenomenon is being demonstrated? Altruism Catharsis Cohesiveness Instillation of hope

Altruism Altruism involves putting another's needs before one's own. This is the only option that correctly identifies with the example provide in the question.REF: 612; Table 34-1

At what point in the life of a group lasting 12 sessions should confidentiality be explained and discussed? At the first session As the working phase begins Just before the group terminates At the time each client is interviewed

At the first session Confidentiality is part of the ground rules that are established at the beginning of the group sessions.REF: 613-614

A term is a synonym for the characteristic of genuineness? Respect Empathy Authentic Positive regard

Authentic Genuineness refers the nurse's ability to be open, honest, and authentic in interactions with patients. It is the ability to meet others person-to-person without hiding behind roles. While positive characteristics, none of the other options related to genuineness.REF: 133

When the group leader suggests that a client "choose the problem that is troubling you most at this time and tell us about it." The leader is promoting what action? Insight Focusing Reframing Feedback

Focusing Focusing helps the group consider one problem rather than trying to attend to multiple problems at one time. None of the other options are associated with selecting a particular focus.REF: 613

During a family therapy session a wife states, "My husband is always angry. The children and I are always on edge. We can never relax." The nurse identifies the wife's communication technique using which term? Placating Distracting Generalizing Manipulating

Generalizing Generalization involves making global statements using "always" and "never" when dealing with problematic family issues. Generalization allows the speaker to avoid dealing with specific examples. None of the other options describes the provided conversation.REF: 624; Box 35-1

Which assessment tool is highly effective in uncovering multigenerational issues in a family? Genogram Focused interview Family function checklist Family assessment device

Genogram A genogram maps family structure and family information for at least three generations. It graphically depicts relational patterns and multigenerational issues. Demographics, sociocultural context, and critical events can be noted. While helpful, none of the remaining options focus on multigenerational issues.REF: 627

A recent immigrant to the United States from which country would find direct eye contact a positive therapeutic technique? Korea Mexico Japan Germany

Germany Eye contact conveys interest to most northern European individuals. Eye contact would be considered intrusive to the others.REF: Page 147-148

The members of a family openly tell each other what they are thinking and feeling. A nurse listening to their interchanges would assess their communication using which term? Generalizing Double-bind Disengaged Healthy

Healthy Healthy communication is exemplified by being clear and direct in saying what you want and need. The other terms are used to describe some form of dysfunctional communication.REF: 623

The nurse would address which of the following goals in attempting to establish a therapeutic nurse-client relationship? Select all that apply. Helping patients examine self-defeating behaviors and test alternatives Promoting self-care and independence Providing the client with opportunities to socialize Assisting patients with problem solving to help facilitate activities of daily living Facilitating communication of distressing thoughts and feelings

Helping patients examine self-defeating behaviors and test alternatives Promoting self-care and independence Assisting patients with problem solving to help facilitate activities of daily living Facilitating communication of distressing thoughts and feelingsAddressing the client's need to socialize is not one of the goals of establishing a therapeutic relationship. The other options are goals addressed in a therapeutic relationship.REF: 125

Which nursing diagnosis for a psychiatric client is correctly structured and worded? Hopelessness related to severe chronic depression Spiritual distress as evidenced by client stating "God has abandoned me because I'm a bad person" Defensive coping related to lack of insight associated with illicit drug use Imbalanced nutrition: less than body requirements related to poor self-concept as evidenced by reporting "I'm not worthy of eating"

Imbalanced nutrition: less than body requirements related to poor self-concept as evidenced by reporting "I'm not worthy of eating" This diagnosis contains all the required components: problem statement, related factors, and defining characteristics.REF: 115

A 17-year-old patient confides to the nurse that they have been thinking of ways to kill a peer. What response should the nurse give when the patient states, "you have to keep it a secret because its confidential information"? "I will keep it a secret, but you and I need to discuss ways to deal with this situation appropriately without committing a crime." "Yes, I will keep it confidential. We have laws to protect patients' confidentiality." "Issues of this kind have to be shared with the treatment team and your parents." "I will have to share this with the treatment team, but we will not share it with your parents."

"Issues of this kind have to be shared with the treatment team and your parents." Although adolescent patients request confidentiality, issues of sexual abuse, threats of suicide or homicide, or issues that put the patient at risk for harm must be shared with the treatment team and the parents. A threat of this nature must be discussed with the treatment team and the parents. Confidentiality laws do not protect information that would lead to harm to the patient or others. DIF: Cognitive Level: Apply (Application)REF: page 7TOP: Nursing Process: ImplementationMSC: NCLEX: Safe and Effective Care Environment

A patient is presenting with behaviors that indicate anger. When approached, the patient states harshly, "I'm fine! Everything's great." Which response should the nurse provide to the patient? "Okay, but we are all here to help you, so come get one of the staff if you need to talk." "I'm glad everything is good. I am going to give you your schedule for the day and we can discuss how the groups are going." "I don't believe you. You are not being truthful with me." "It looks as though you are saying one thing but feeling another. Can you tell me what may be upsetting you?"

"It looks as though you are saying one thing but feeling another. Can you tell me what may be upsetting you?" This response uses the therapeutic technique of clarifying; it addresses the difference between the patient's verbal and nonverbal communication and encourages sharing of feelings. The other options do not address the patient's obvious distress or are confrontational and judgmental. None of the other options provides this support.DIF: Cognitive Level: Analyze (Analysis)REF: pages 7-9TOP: Nursing Process: ImplementationMSC: NCLEX: Psychosocial Integrity

A nurse on the psychiatric unit has a past history of alcoholism and has regular meetings with a mentor. Which statement made to the nurse's mentor would indicate the presence of countertransference? "My patient is being discharged tomorrow. I provided discharge teaching and stressed the importance of calling the help line number should she become suicidal again." "My patient has been abusing alcohol. I told her that the only way to recover was to go 'cold turkey' and to get away from her dysfunctional family and to do it now!" "My patient started drinking after 14 years of sobriety. We are focusing on his treatment plan of attending AA (Alcoholics Anonymous) meetings five times a week after discharge." "My patient, is an elderly woman with depression. She calls me by her daughter's name because she says I remind her of her daughter."

"My patient has been abusing alcohol. I told her that the only way to recover was to go 'cold turkey' and to get away from her dysfunctional family and to do it now!" This statement indicates countertransference; the nurse may be overidentifying with the patient because of a past history of alcoholism. Providing adamant advice to the patient that, besides being nontherapeutic, may be more relevant to personal past experiences than to the patient's. The discharge teaching for a patient being discharged and focusing on the treatment plan for the alcoholic patient are appropriate and show no signs of countertransference. The patient calling the nurse by her daughter's name is transference rather than countertransference.DIF: Cognitive Level: Analyze (Analysis)REF: pages 11, 12TOP: Nursing Process: EvaluationMSC: NCLEX: Psychosocial Integrity

Consider the nurse-patient relationship on an inpatient psychiatric unit. Which of the following statements made by the nurse reflects an accurate understanding of when the issue of termination should first be discussed? "You are being discharged today, so I'd like to bring up the subject of termination—discussing your time here and summarizing what coping skills you have attained." "I haven't met my new patient yet, but I am working through my feelings of anxiety in dealing with a patient who wanted to kill herself." "Now that we are working on your problem-solving skills and behaviors you'd like to change, I'd like to bring up the issue of termination." "Now that we've discussed your reasons for being here and how often we will meet, I'd like to talk about what we will do at the time of your discharge."

"Now that we've discussed your reasons for being here and how often we will meet, I'd like to talk about what we will do at the time of your discharge." The issue of termination is brought up first in the orientation phase. All the other options describe other phases of the nurse-patient relationship—the termination phase, the preorientation phase, and the working phase.DIF: Cognitive Level: Analyze (Analysis)REF: page 18TOP: Nursing Process: ImplementationMSC: NCLEX: Psychosocial Integrity

What is the most helpful nursing response to a client who reports thinking of dropping out of college because it is too stressful? "Don't let them beat you! Fight back!" "School is stressful. What do you find most stressful?" "I know just what you are going through. The stress is terrible." "You have only two more semesters. You will be glad if you stick it out."

"School is stressful. What do you find most stressful?" This response acknowledges the speaker's perception of school as difficult and asks for further information. This response suggests the nurse is listening actively and is concerned.REF: 142

A patient who recently loss a parent begins crying during a one-to-one session with the nurse. Which of the following responses by the nurse illustrates empathy? "I'm so sorry. My father died 2 years ago, so I know how you are feeling." "You need to focus on yourself right now. You deserve to take time just for you." "That must have been such a hard situation for you to deal with." "I know that you will get over this. It just takes time."

"That must have been such a hard situation for you to deal with." This response reflects understanding of the patient's feelings, which is empathy. Feeling sorry for the client represents sympathy, whereas not addressing the patient's concern belittles the patient's feelings of grief she is expressing by changing the subject. Telling the patient she will get over it does not reflect empathy and is closed-ended.DIF: Cognitive Level: Analyze (Analysis)REF: pages 22, 23TOP: Nursing Process: ImplementationMSC: NCLEX: Psychosocial Integrity

Which statement regarding clients' rights after being voluntarily admitted to a behavioral health unit is true? All rights remain intact. Only rights that do not involve decision making remain intact. The right to refuse treatment is no longer guaranteed. All rights are temporarily suspended.

All rights remain intact. The hospitalized client is not a convicted criminal thus all civil rights remain intact.REF: 70

Which response should the nurse provide a client who asks, "Why you need to conduct an assessment interview"? "I need to find out more about you and the way you think in order to best help you." "The assessment interview lets you have an opportunity to express your feelings." "You are able to tell me in detail about your past so that we can determine why you are experiencing mental health alterations." "We will be able to form a relationship together where we can discuss the current problems and come up with goals and a plan for treatment."

"We will be able to form a relationship together where we can discuss the current problems and come up with goals and a plan for treatment." Some of the purposes of the assessment interview are to establish rapport, learn more about the presenting issues, and form mutual goals and a plan for treatment. The other options do not appropriately explain the assessment purpose.DIF: Cognitive Level: Analyze (Analysis)REF: page 9TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity

The nurse best assesses the client's spiritual life by asking which question? "Do you practice a specific religion?" "To whom do you turn in times of crisis?" "Do you attend church regularly?" "What role does religion play in your life?"

"What role does religion play in your life?" Asking the client to define the role of religion in their life allows for discussion related to the other topics.REF: 113-114

What response demonstrates an effective strategy to encourage a nonparticipating member to speak during a group session? "You are letting the group down when you fail to contribute." "Your opinions about what just happened are important." "You must be feeling safe enough to enter the discussion by now." "What you are thinking is very important to the group."

"What you are thinking is very important to the group." Options A, B, and C place the client on the defensive and encourage further withdrawal. Option D is less threatening. The leader needs to be patient and, in a nonthreatening manner, encourage members to make contributions.REF: 617

Which of the following statements represent a nontherapeutic communication technique? Select all that apply. "Why didn't you attend group this morning?" "From what you have said, you have great difficulty sleeping at night." "What did your boyfriend do that made you leave? Are you angry at him? Did he abuse you in some way?" "If I were you, I would quit the stressful job and find something else." "I'm really proud of you for the way you stood up to your brother when he visited today." "You mentioned that you have never had friends. Tell me more about that." "It sounds like you have been having a very hard time at home lately."

"Why didn't you attend group this morning?" "What did your boyfriend do that made you leave? Are you angry at him? Did he abuse you in some way?" "If I were you, I would quit the stressful job and find something else." "I'm really proud of you for the way you stood up to your brother when he visited today." All these options reflect the nontherapeutic techniques of (in order) asking "why" questions; using excessive questioning; giving advice; and giving approval. The other options describe therapeutic techniques of restating, exploring, and reflecting.

A 26-year-old patient is brought to the emergency room by a friend. The patient is unable to give any coherent history. Which response should the nurse provide when the patient's friend offers to provide information regarding the patient? "I'm sorry, but I cannot take any information from you as it would violate confidentiality laws." "There is no need for that as I will call his primary care provider to obtain the information we need." "Yes, I will be happy to get any information and history that you can provide." "Yes, however, we will have to get a release signed from the patient for you to be able to talk with me."

"Yes, I will be happy to get any information and history that you can provide." The friend is a secondary source of information that will be helpful since the patient is not able to give any history or information at this time. Confidentiality laws do not prohibit obtaining information from a secondary source. The friend can provide information and/or history immediately and may be able to relate events that happened just before coming to the hospital. A release would not be necessary to take information about the patient from a secondary source, and a psychotic patient would not be competent to sign a release.DIF: Cognitive Level: Apply (Application)REF: page 6TOP: Nursing Process: AssessmentMSC: NCLEX: Safe and Effective Care Environment

A client has been admitted to your inpatient psychiatric unit with suicidal ideation. In a one-to-one session with the nurse, he shares the terrible guilt he feels over sexually abusing his stepdaughter and wanting to die because of it. Which of the following responses you could make reflects a helpful trait in a therapeutic relationship? "It's good that you feel guilty. That means you still have a chance of being helped." "Of course you feel guilty. You did a horrendous thing. You shouldn't even forget what you did." "The biggest question is, will you do it again? You will end up having even worse guilt feelings because you hurt someone again." "You are suffering with guilt over what you did. Let's talk about some goals we could work on that may make you want to keep living."

"You are suffering with guilt over what you did. Let's talk about some goals we could work on that may make you want to keep living." This response demonstrates suspending value judgment, a helpful trait in establishing and maintaining a therapeutic relationship. Although it is difficult, nurses are more effective when they don't use their own value systems to judge patients' thoughts, feelings, or behaviors. The other options are all judgmental responses. Judgment on the part of the nurse will most likely interfere with further explorations of feelings and hinder the therapeutic relationship.DIF: Cognitive Level: Analyze (Analysis)REF: pages 25 TOP: Nursing Process: ImplementationMSC: NCLEX: Psychosocial Integrity

A client on the psychiatric unit who is scheduled to start group therapy asks the nurse, "What does group work mean? I was told I would be going to group and doing group work." How should the nurse respond to provide the best answer to the client's question? "You will attend group therapy and find solutions for each other's problems." "You will give and receive feedback from a group of your peers who may also have similar problems to work through." "You will share your issues with the group and then split up to work separately on solutions based on the ideas the other members provide." "Group work is the work that you do beforehand so you can present it to the group when you meet."

"You will give and receive feedback from a group of your peers who may also have similar problems to work through." Group work is a method whereby individuals with a common purpose come together and benefit by mutually giving and receiving feedback within the dynamic and unique group context. None of the other options accurately and adequately describe group work.DIF: Cognitive Level: Apply (Application)REF: Table 34-1TOP: Nursing Process: PlanningMSC: NCLEX: Psychosocial Integrity

With which client should the nurse make the assessment that not using touch would probably be in the client's best interests? A recent immigrant from Russia A deeply depressed client A Chinese American client A tearful client reporting pain

A Chinese American client Chinese Americans may not like to be touched by strangers since it is a cultural characteristic.REF: 148

What are the advantages of therapy groups? Select all that apply. Feedback from peers Treatment of multiple people at one time Promotion of independence in problem solving Provision of an opportunity to practice communication Promotion of a feeling of belonging Promotion of confidentiality

All these options are advantages of groups. Since the members openly discuss and provide feedback, confidentiality is not possible.

Which family situation should the nurse assess as warranting a referral for family therapy? A couple is having their first child. They say, "It's certainly going to be a change for us." A husband and wife are sending a son off to college and planning their daughter's wedding. They say, "Soon we will be back to having an empty nest again." A couple is having difficulty dealing with the erratic behavior of their bipolar son. They say, "We're at the end of our rope." The parents of a blended family with five children ranging in age from 5 to 15 years say, "It's never quiet, but the disagreements eventually get worked out."

A couple is having difficulty dealing with the erratic behavior of their bipolar son. They say, "We're at the end of our rope." The family in option C is the only family system clearly expressing an unmanageable degree of stress. The other systems may be undergoing stress but have not expressed distress.REF: 622

A democratic group leadership style is most appropriate for which purpose? 30-minute meetings to discuss unit rules Creating meaningful trauma-related artwork A group directed toward anger management The organization the unit's holiday celebration

A group directed toward anger management Democratic leadership is best implemented when extensive group interaction is devoted to problem solving. None of the other options is problem solving in its focus.REF: 615

Of the following environments, which would be most conducive to a therapeutic session? The nurses' station A table in the coffee shop A quiet section of the day room The utility room

A quiet section of the day room Of the options provided, a quiet corner of the day room offers the safest, quietest, most private environment for a therapeutic encounter. None of the other options offer these characteristics.REF: 140-149

Which situation is the best example of a double bind? A wife sighs while telling her husband, "You can go out with the boys tonight if it's what you really want to do." A mother tells her son, "Under no circumstances will I give you permission to stay out after midnight." A roommate states, "I would prefer to have you call if you think you are going to be late for dinner." A man says, "I was surprised and delighted when my entry was chosen for an award."

A wife sighs while telling her husband, "You can go out with the boys tonight if it's what you really want to do." A double bind is created when the verbal and nonverbal messages are incongruent, leaving the listener confused or trapped ("damned if he does and damned if he doesn't"). None of the other options present such a confused message.REF: 626; Box 35-2

During a clinical interview the client falls silent after disclosing that she was sexually abused as a child. The nurse should engage in which intervention in response to the client's silence? Quickly break the silence and encourage the client to continue. Reassure the client that the abuse was not her fault. Reach out and gently touch the client's arm. Allow the client to break the silence.

Allow the client to break the silence. Silence is not a "bad" thing. It gives the speaker time to think through a point or collect his or her thoughts. None of the other options will assist with further communication with this client.REF: 141-142

The nurse is conducting an admission interview with a client who was raped 2 weeks ago. When asked about the rape, the client becomes very anxious and upset and begins to sob. What should be the nurse's response to the client's reaction? Push gently for more information about the rape because the information needs to be documented. Acknowledge that the topic of the rape is upsetting and reassure the client that it can be discussed at another time when she feels more comfortable. Use silence as a therapeutic tool and wait until the client is done sobbing to continue discussing the rape. Reassure the client that anything she says to you will remain confidential.

Acknowledge that the topic of the rape is upsetting and reassure the client that it can be discussed at another time when she feels more comfortable. The best atmosphere for conducting an assessment is one with minimal anxiety on the patient's part. If a topic causes distress, it is best to abandon the topic at that time. It is important not to pry or push for information that is difficult for the patient to discuss. The use of silence continues to expect the patient to discuss the topic now. Reassurance of confidentiality continues to expect the patient to discuss the topic now.DIF: Cognitive Level: Apply (Application)REF: page 5TOP: Nursing Process: PlanningMSC: NCLEX: Psychosocial Integrity

The case manager is demonstrating an understanding of the primary goals of managed care when engaging in which client intervention? Arranging for the client to have a screening for prostate cancer Notifying the family that the client will require a wheelchair when discharged Providing the client with organizations that help defray the cost of prescribed drug Arranging for respite care when the client's family needs to attend an out-of-state affair

Arranging for the client to have a screening for prostate cancer The goal of managed care is to provide coordination of all health services with an emphasis on preventive care. While appropriate interventions, none of the remaining options focus on preventive care.REF: 64

When a member tells the group, "I think the committee saw how unsure of myself I am. I felt all shaky inside during the promotion interview, just like I am feeling and acting right now." To present reality the leader should provide which response? Remain silent and nod slightly to signal that the client should continue. Say, "Tell us more about how you are feeling." Ask, "Does this shaky feeling occur often?" Ask the group to give feedback about how the client appears to them.

Ask the group to give feedback about how the client appears to them. This option is the only one that will result in present reality. The client will learn more about the reality of how he appears to others. The remaining options either give encouragement to continue or seek additional information.REF: 612; Table 34-1

Which communication techniques should the nurse use with a client who has been identified as having difficulty expressing thoughts and feelings? Using emotionally charged words and gestures Offering opinions and avoiding periods of silence Asking closed-ended questions requiring "yes" or "no" answers Asking open-ended questions and seeking clarification

Asking open-ended questions and seeking clarification Open-ended questions give the client the widest possible latitude in answering. Also, the client can take the lead in the interview. Seeking clarification helps the client clarify his or her own thoughts and promotes mutual understanding. None of the options provide this support.REF: 142-143

What is the primary function of the nurse generalist in caring for families? Assessing the amount of stress on the system Conducting private family therapy sessions Prescribing psychobiological intervention Determining the new skills the family needs

Assessing the amount of stress on the system An important function of a nurse generalist is to assess cues from various family members that indicate the degree and amount of stress the family system is experiencing and report these so that appropriate interventions may be made in a timely manner by a qualified counselor. The remaining options are outside the scope of practice of a psychiatric nurse generalist.REF: 628-629

A nurse is about to interview an older client whose glasses and hearing aid were placed in the bedside drawer for safe keeping. Before beginning the interview, which nursing intervention that will best facilitate data collection? Ask the client if she needs her glasses and hearing aid. Give the client her glasses and hearing aid. Assist the client in putting on glasses and hearing aid. Explain the importance of wearing her hearing aid and glasses.

Assist the client in putting on glasses and hearing aid. A client whose hearing or sight is impaired may have difficulty providing information if these items have been removed from his or her possession. Assisting the client in wearing these assistive devices is the best initial intervention. None of the other options will be as effective in facilitating the interview.REF:111-112

The nurse is finding it difficult to provide structure and set limits for a client. The nurse should self-evaluate for which characteristic of a dysfunctional nurse-patient relationship? Boundary blurring Value dissonance Covert anger Empathy

Boundary blurring Boundary blurring is often signaled by the nurse being either too helpful or not helpful enough. The behavior is not associated with any of the other options.REF: 127

When a nurse says, "I work with a mobile mental health unit," what assumption can a client accurately make about the care being provided? The patients who are convicted criminals sentenced to home confinement. Care is provided to clients in unconventional settings. Care is provided by a preferred provider for a large HMO. The patients are provided for by a clinical specialist with the visiting nurse service.

Care is provided to clients in unconventional settings. Mobile mental health units travel throughout the community, seeing clients on their own "turf," such as in shelters, on street corners, in homes, and at factories.REF: 67-68

When discussing her husband, a client shares that "I would be better off alone. At least I would be able to come and go as I please and not have to be interrogated all the time." What therapeutic communication technique is the nurse using when responding, "Are you saying that things would be better if you left your husband?" Focusing Restating Reflection Clarification

Clarification Clarification verifies the nurse's interpretation of the client's message. None of the other options are associated with the verification of the client's meaning.REF: 142

After a client discusses his/her relationship with his/her father, the nurse asks, "Tell me if I'm correct that you feel dominated and controlled by him?" What is the purpose of the nurse's question? Eliciting more information Encouraging evaluation Verbalizing the implied Clarifying the message

Clarifying the message Clarification helps the nurse understand and correctly interpret the client's message. It gives the client the opportunity to correct misconceptions. This is not the purpose of any of the other options.REF: 142

A key quality indicator that might be identified for successful outcome in a medication education group could be that clients will engage in which activity? Stating they respected the leader Demonstrating a bond among members of the group Describe modes of transmission of sexually transmitted diseases Confer with health care provider before changing medication regimen

Confer with health care provider before changing medication regimen The key quality indicator that relates to successful outcomes in a medication education group is the client's recognition of the need to discuss medication changes with his or her physician rather than adjusting the dose or stopping the medication without consultation. None of the other options are associated with the focus of medication education.REF: 616; Table 34-5

During a therapeutic encounter, the nurse makes an effort to ensure the use of two congruent levels of communication. What is the rationale for this? The mental image of a word may not be the same for both nurse and client. One statement may simultaneously convey conflicting messages. Many of the client's remarks are no more than social phrases. Content of messages may be contradicted by process.

Content of messages may be contradicted by process. Verbal messages may be contradicted by the nonverbal message that is conveyed. The nonverbal message is usually more consistent with the client's feelings than the verbal message. None of the remaining options are so directly associated with assuring congruency.REF: 140-141

In order to be most effective, the community mental health nurse involved in assertive community treatment (ACT) needs to possess which characteristic? Knowledge of both national and local political activism The ability to cross service systems An awareness of own cultural and personal values Creative problem-solving and intervention skills

Creative problem-solving and intervention skills Creative problem-solving and intervention skills are the hallmark of care provided by the ACT team.REF: 67

The outcome of the nurse's expressions of sympathy instead of empathy toward the client often leads to which outcome? Enhanced client coping Lessening of client emotional pain Increased hope for client improvement Decreased client communication

Decreased client communication Sympathy and the resulting projection of the nurse's feelings limit the client's opportunity to further discuss the problem. The remaining options are positive outcomes.REF: 133

During a family therapy session the mother says to her daughter, "I would like to know why you took the piece of pie that was left after dinner last night. You knew I wanted it." Later the father tells his daughter, "I know exactly why you did that." The nurse therapist should consider the possibility that the family is demonstrating which boundary issue Clear Diffused Disengaged Inflexible

Diffused A common phenomenon within families with diffuse boundaries is that individuals expect other members of the family to know what they are thinking. The described conversation is not reflective of any of the other options.REF: 626; Box 35-2

What is the group leader's responsibility in the termination phase? Allowing members to exchange contact information so they may remain as a support for each other. Removing himself or herself from the group so they can function independently. Encouraging group members to reflect on progress made while providing group feedback. Encouraging group members to fill out evaluation forms so the group leader can further improve his or her therapeutic technique.

Encouraging group members to reflect on progress made while providing group feedback. In the termination phase, the group leader's role is to encourage members to reflect on progress they have made and identify posttermination goals. Contact with other members in the group outside of the group is not therapeutic and is usually discouraged. The group leader does not remove himself or herself from the group process. Group members do not fill out evaluation forms in group therapy.DIF: Cognitive Level: Apply (Application)REF: page 6TOP: Nursing Process: ImplementationMSC: NCLEX: Psychosocial Integrity

What is the primary advantage of using a case manager when considering the planning and implementation of client care? Increases collaborative practice. Enhances resource management. Increases client satisfaction with care. Promotes evidence-based psychiatric nursing.

Enhances resource management. Case management coordinates and monitors the effectiveness of services appropriate for the client. While the other options are true statements, none describes the primary advantage of the case manager model of health care delivery.REF: 66-67

What term best describes a family dynamic where boundaries are not clear and whose members are overinvolved with each other? Clear boundaries Enmeshment Scapegoating Rigid boundaries

Enmeshment When boundaries are diffuse, individuals tend to become "enmeshed." As a consequence, it is not clear who is in charge, who is responsible for decisions, and who has permission to act or take charge; family members are often overinvolved with each other. Clear boundaries are adaptive and healthy. They are well understood by all members of the family and give family members a sense of "I-ness" and also "we-ness." Scapegoating refers to a situation in which one member of the family is seen as the cause of all the problems. Rigid boundaries are characterized by the consistent adherence to rules and roles—some apparent and some less so—no matter what.DIF: Cognitive Level: Understand (Comprehension)REF: Box 35-2TOP: Nursing Process: DiagnosisMSC: NCLEX: Psychosocial Integrity

A family consists of a husband, a wife, their three children, and the wife's mother. This family form is referred to using which term? Extended Dyadic Blended Indwelling

Extended An extended family (multigenerational) is a composite of three or more generations. None of the other options refer to this family composition.REF: 622

Which of the following statements are true regarding the differences between a social relationship and a therapeutic relationship? Select all that apply. In a social relationship, both parties' needs are met; in a therapeutic relationship, only the patient's needs are to be considered. A social relationship is instituted for the main purpose of exploring one member's feelings and issues; a therapeutic relationship is instituted for the purpose of friendship. Giving advice is done in social relationships; in therapeutic relationships giving advice is not usually therapeutic. In a social relationship, both parties come up with solutions to problems and solutions may be implemented by both (a friend may lend the other money, etc.); in a therapeutic relationship, solutions are discussed but are only implemented by the patient. In a social relationship, communication is usually deep and evaluated; in a therapeutic relationship, communication remains on a more superficial level, allowing patients to feel comfortable.

In a social relationship, both parties' needs are met; in a therapeutic relationship, only the patient's needs are to be considered. Giving advice is done in social relationships; in therapeutic relationships giving advice is not usually therapeutic. In a social relationship, both parties come up with solutions to problems and solutions may be implemented by both (a friend may lend the other money, etc.); in a therapeutic relationship, solutions are discussed but are only implemented by the patient. The other options describe the opposite meanings of social and therapeutic relationships.

What principle forms the basis of nursing outcome planning? Individuals have the right to outcomes that is reflective of their abilities. Nursing interventions are designed to solve individuals' problems for them. The goal of nursing action is to create a dependency between the client and the caregiver. Nurses have the best understanding of client problems and so they direct outcome selection.

Individuals have the right to outcomes that is reflective of their abilities. Outcome criteria are the hoped-for outcomes that reflect the maximal level of patient health that the patient can realistically achieve through nursing interventions. None of the other options accurately describes the guiding principle of outcome planning.REF: 116

A therapeutic inpatient milieu will include which characteristic? It provides for the client's safety and comfort. Voluntarily admitted clients are generally allowed additional privileges. Rules and behavioral limits are flexibly enforced. Staff provide frequent and ongoing negative feedback to clients.

It provides for the client's safety and comfort. Because the acuity level on inpatient units is high, nurses are responsible for ensuring that the environment is safe and that elopement and self-harm opportunities are minimized. The other choices are undesirable characteristics of a therapeutic milieu.REF: 71

The advanced practice nurse running a group on the adolescent unit makes no attempt to control the topic and makes no comment unless asked a direct question. What leadership style is the nurse implementing? Autocratic Authoritarian Democratic Laissez-faire

Laissez-faire A laissez-faire leader allows the group members to behave in any way they choose and does not attempt to control the direction of the group. Autocratic leaders control the group, pick the topic, and do not allow for much interaction. Authoritarian is another word for autocratic. A democratic leader involves the group members in decision making.DIF: Cognitive Level: Apply (Application)REF: page 9TOP: Nursing Process: ImplementationMSC: NCLEX: Psychosocial Integrity

A girl is overheard saying to her brother, "If you stick up for me with mom and dad, I will forget I heard you planning to sneak out after they are asleep." This can be assessed as what type of communication? Manipulative Scapegoating Generalizing Placating

Manipulative One example of manipulation occurs when a family member makes a request with strings attached so that the other person has difficulty refusing. This example is not associated with any of the other options.REF: 624; Box 35-1

What function is shared by advanced practice and general practice psychiatric nurses? Prescriptive authority Admitting privileges Offers consultation services Membership on a multidisciplinary team

Membership on a multidisciplinary team Nurses at both levels are expected to collaborate with multidisciplinary teams; only the advanced practice nurse has prescriptive authority and admitting privileges and can provide consultation.REF: 65-66

The nurse reading in a group's protocol notes that it is a closed group understands that the group demonstrates which characteristic? Discussion topics will be restricted. Membership is limited to one gender. No new members will be allowed. The group is focused on demonstrating cohesiveness.

No new members will be allowed. A closed group is one to which no members are added once the group has begun. The term closed does not refer to any of the other options.REF: 612; Box 34-3

A patient is sitting with arms crossed over his or her chest, his or her left leg is rapidly moving up and down, and there is an angry expression on his or her face. When approached by the nurse, the patient states harshly, "I'm fine! Everything's great." Which statement related to communication should the nurse focus on when working with this patient? Verbal communication is always more accurate than nonverbal communication. Verbal communication is more straightforward, whereas nonverbal communication does not portray what a person is thinking. Nonverbal and verbal communication may be different; nurses must pay attention to the nonverbal communication being presented to get an accurate message. Nonverbal communication is about 10% of all communication, and verbal communication is about 90%.

Nonverbal and verbal communication may be different; nurses must pay attention to the nonverbal communication being presented to get an accurate message. Communication is roughly 10% verbal and 90% nonverbal, so nurses must pay close attention to nonverbal cues to accurately assess what the patient is really feeling. The other options are all untrue of verbal and nonverbal communication and are actually the opposite of what is believed of communication.DIF: Cognitive Level: Analyze (Analysis)REF: pages 7-9TOP: Nursing Process: PlanningMSC: NCLEX: Psychosocial Integrity

Most clients who are diagnosed with chronic mental illness are not likely to have their psychiatric mental health experiences covered by which payment method? Private insurance Medicare Medicaid Private pay

Private insurance Because most health insurance is employer based, few chronically ill clients have private insurance. The other options are examples of ways patients pay for their needed mental health services.REF: 69-70

What three structural components comprise a nursing diagnosis? Problem, outcome, intervention Problem, related factors, defining characteristics Unmet need, goal, outcome criterion Presenting symptom, treatment, goal

Problem, related factors, defining characteristics The components of the nursing diagnosis are problem, related factors, and defining.REF: 115

The family that consists of a married mother and father and three biological children all living together is referred to using which term? Blended family Cohabitating family Nuclear family Other family

Nuclear family A nuclear family consists of one or more children who live with married parents who are the biological or adoptive parents to all the children. Blended family refers to one or more children living with a biological or adoptive parent and an unrelated stepparent who are married to each other. Cohabitating family refers to one or more children living with a biological or adoptive parent and an unrelated adult who are cohabitating. "Other" refers to one or more children living with related or unrelated adults who are not biological or adoptive parents. This includes children living with grandparents and foster families.DIF: Cognitive Level: Remember (Knowledge)REF: page 4TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity

In addition to physicians, what other members of the mental health disciplines have been identified as having the knowledge, skills, ability, and legal authority to intervene in the full range of mental health care? Nurses Social workers Clinical psychologists Chemical dependency counselors

Nurses Nurses are the only caregivers listed who can provide both physical and psychological care for mental health clients.REF: 65-66

Which tool can the novice nurse might refer to when writing nursing outcomes? North American Nursing Diagnosis Association (NANDA) Joint Commission (formally JCAHO) Nursing Interventions Classification (NIC) Nursing Outcomes Classification (NOC)

Nursing Outcomes Classification (NOC) The Nursing Outcomes Classification is a publication used as a resource across the United States. It is a standardized list of nursing outcomes that gives nurses a way to evaluate the effect of nursing interventions. That is not the function of any of the other options.REF: 116

The mental status examination aids in the collection of what type of data? Covert Physical Objective Subjective

Objective The mental status exam mostly aids in the collection of objective data.REF: 112

During what stage of the therapeutic nurse-client relationship is a formal or informal contract between the nurse and client established? Preorientation Orientation Working Termination

Orientation Contracting is part of the orientation phase of the relationship. Establishing the operational "rules" provides a foundation for the relationship. This function is not associated with any of the other options.REF: 130-131

At what phase of group development would the nurse hear the following interchange? Client 1: "I do not feel comfortable here." Client 2: "I wonder what we are supposed to talk about." Client 3: "Let's ask the leader to explain things again." Preorientation Orientation Working Termination

Orientation During orientation the members get to know one another. Initially, they experience anxiety and are unsure of the expectations.REF: 613

Which group phase is most influenced and managed by the group leader? Orientation Working Termination Post-termination

Orientation The group leader often is most directive in the orientation phase, in which roles and ground rules are set. No other phase is so managed by the leader.REF: 612-613

A client tells the nurse "I really feel close to you. You are like the friend I never had." The nurse can assess this statement as indicating the client may be experiencing which unconscious emotion? Congruence Empathetic feelings Countertransference Positive transference

Positive transference Transference involves the client experiencing feelings toward a nurse that belong to a significant person in the client's past. If a patient is motivated to work with you, completes assignments between sessions, and shares feelings openly, it is likely the patient is experiencing positive transference. The behavior is not associated with any of the other options.REF: 127-128

The group goals are to learn to express feelings comfortably rather than keep them covert. When a group member shares with the group how expressing these feelings makes her feel, she is engaging in what activity? Group content Confrontation Subgrouping Providing feedback

Providing feedback Feedback includes letting the group know how they and the comments made in group make the individual feel. This form of sharing is not associated with any of the other options.REF: Box 34-2

A nuclear family consists of married parents, a 16-year-old daughter, and a 19-year-old son recently diagnosed with schizophrenia. The rest of the family is bewildered with his symptoms and express that they feel lost in knowing how to deal with things. Which of the following approaches to family therapy should the nurse implement at this time to provide support and give information to the family that will help them cope with their son's illness? Insight-oriented family therapy Psychoeducational family therapy Behavioral family therapy Multigenerational family therapy

Psychoeducational family therapy The primary goal of psychoeducational family therapy is the sharing of mental health care information. This helps family members better understand their member's illness, prodromal symptoms (symptoms that may appear before a full relapse), medications needed to help reduce the symptoms, and more. Psychoeducational family meetings allow feelings to be shared and strategies for dealing with these feelings to be developed. Insight-oriented therapy focuses on developing increased self-awareness, other awareness, and family awareness among family members. Behavioral family therapy focuses on changing behaviors of family members to influence overall patterns of family interactions. The last option is a distractor and is incorrect.DIF: Cognitive Level: Analyze (Analysis)REF: page 13TOP: Nursing Process: PlanningMSC: NCLEX: Psychosocial Integrity

During a therapeutic encounter the nurse remarks to a client, "I noticed anger in your voice when you spoke of your father. Tell me about that." What communication techniques is the nurse using? Giving information and encouraging evaluation Presenting reality and encouraging planning Clarifying and suggesting collaboration Reflecting and exploring

Reflecting and exploring Reflecting conveys the nurse's observations of the client when a sensitive issue is being discussed. Exploring seeks to examine a certain idea more fully.REF: 142

The client's priority nursing diagnosis has been established as risk for self-directed violence: suicide related to multiple losses. What is the priority outcome for this client? Refrain from attempting suicide. Be placed on suicide precautions. Attend self-help group daily. State absence of feelings of powerlessness.

Refrain from attempting suicide. Refraining from suicidal attempts is the only outcome that addresses the risk for self-directed violence. The absence of a feeling of powerlessness is not appropriate for the stated nursing diagnosis. The remaining options are interventions.REF: 116-117

During family therapy the family's youngest daughter says, "They care more about my sister because she's older and gets straight As in school." Which nursing diagnosis should be given priority? Deficient knowledge Parental role conflict Defensive coping Relational problems

Relational problems This discourse concerns relational problems related to a mental disorder, a generic medical condition, or a sibling relational problem. No data suggests the other diagnoses.REF: 628; Box 35-3

A patient diagnosed with borderline personality disorder is attending a court-ordered therapy group. The patient projects an angry affect, does not speak much, except to make a snide comment about another member of the group or the group's leader. What is the best way for the leader to handle this patient's behavior? Remove the patient from the group because this behavior is disrupting the group process for other participants. Respond neutrally to the patient's comments, ask for group feedback, and talk privately with the patient to form a therapeutic connection. Spend an entire group session focused on that patient and try to get him/her to open up to other members in depth. Confront the patient firmly each time he/she makes a rude comment and let him/her know they will be taken out of group if the behavior continues.

Respond neutrally to the patient's comments, ask for group feedback, and talk privately with the patient to form a therapeutic connection. The group leader should listen to the comments objectively and without becoming defensive. The leader may choose to speak to the group member in private and ask what is causing the anger, to form a connection with the patient that may result in less disruptive behavior in group. In the group setting, the leader can focus on positive group members whose comments may reduce the hostility of the negative group member. Part of the group process includes problem-solving skills and getting group feedback for issues. Spending an entire session discussing one patient is inappropriate in a group setting. Confrontation done on a continual basis would disrupt the group process and focus heavily on the hostile client.DIF: Cognitive Level: Apply (Application)REF: page 12TOP: Nursing Process: PlanningMSC: NCLEX: Psychosocial Integrity

Which criterion is essential when the nurse plans nursing interventions designed to meet a specific goal? Select all that apply. Safe Evidence based Individualized Economical Realistic

Safe Evidence based Individualized Realistic Although expense should be considered, interventions are chosen based on being safe, compatible and appropriate, realistic and individualized, and evidence based and not on their economic value.REF: 116-117

Sharing similar experiences in a group setting is referred to using which term? Universality Imparting information Socializing Catharsis

Universality The phenomenon of understanding that one's problems are not unique helps group members feel secure and understood. No other option is used to describe this group behavior.REF: 611

At the first therapy session the family's father tells the therapist that "We wouldn't have to be here if our younger son wasn't such a brat. He seems so different from our other son. We never had difficulty with him misbehaving." The other sibling offers "He gets upset pretty easily." The nurse should suspect that the younger son is the focus of which family dynamic behavior? Scapegoating Boundaries resisting Differentiation Multigenerational transition.

Scapegoating A scapegoat is the person others blame for the family's distress. Those blaming the scapegoat are usually trying to keep the focus off their own painful issues and problems. The parents seem to be scapegoating the younger son. The information presented does not support any of the other options.REF: 626; Box 35-2

A 43-year-old client being seen in the mental health clinic states, "I have always been a practicing Jew, but in the past few months I am questioning everything. I just don't know if I believe in it anymore." Which of the following nursing diagnoses best describes the client's comment? Ineffective coping Spiritual distress Risk for self-harm Hopelessness

Spiritual distress The client is expressing distress regarding his religion and spiritual well-being. The client could be experiencing ineffective coping, but this does not directly relate to his comment. There is nothing in the client's comment that would lead to the conclusion that the patient is having thoughts of harming himself or experiencing hopelessness.DIF: Cognitive Level: Analyze (Analysis)REF: page 12TOP: Nursing Process: DiagnosisMSC: NCLEX: Psychosocial Integrity

When several group members always sit together and nod or smirk as others are talking, the leader assesses this behavior using which term? Confronting Blocking Subgrouping Imitating

Subgrouping Subgrouping involves formation of a splinter group within the larger group. Members of the subgroup show more loyalty to each other than to the larger group. None of the other options are associated with behavior.REF: 612; (Box 34-3)

When a client is encouraged to talk with others who have had similar problems, the nurse is suggesting a which type of group? Cognitive-behavioral Time-limited Support group Milieu group

Support group Support groups are composed of members who have had or are currently sharing similar experiences, such as a bereavement group or a group of women with breast cancer. None of the other options have this specific purpose as its focus.REF: 616; Table 34-5

Which phase of group therapy does the group deal with feelings associated with separation and loss? Orientation Working Termination Post-termination

Termination During termination, the group members must face the fact that they are at a parting of the ways. Unresolved feelings associated with other terminations and separations may surface and need to be addressed. None of the other options are focused on the emotions associated with the ending of the group experience.REF: 613

Which phase of the nurse-client relationship may cause client anxieties to reappear and past losses to be reviewed? Preorientation phase Orientation phase Working phase Termination phase

Termination phase Termination, a stage in which the client must face the loss or ending of the therapeutic relationship, often reawakens the pain of earlier losses. This is not generally associated with the other phases.REF: 132-133

A 26-year-old client diagnosed with schizophrenia is having difficulty adjusting to the community after hospitalization. His family is dismayed by his poor hygiene and avolition. Which intervention should the nurse suggest? The client attending a psychoeducational group Close supervision of the client by the family Encourage the family to ignore all symptoms except delusions. Suggest group home living for the client in order to avoid family burnout.

The client attending a psychoeducational group Psychoeducation can help the family learn to accept the illness of a family member, learn to deal effectively with symptoms, and understand medications. None of the other options provide a realistic, effective intervention to manage this client's socialization and self-care issues.REF: 624-625

Which criterion must be met to refer a client to a partial hospitalization program? The client is hospitalized at night in an inpatient setting. The client must be able to provide his or her own transportation daily. The client is able to return home each day. The clients are all recovering from an addiction.

The client is able to return home each day. Returning home each day is a criterion because doing so allows the person to test out new skills and gradually re-enter the family and society. None of the remaining options are true statements regarding partial hospitalization programs.REF: 67

The preferred seating arrangement for a nurse-client interview should incorporate which positioning? The nurse behind a desk and the client in a chair in front of the desk. The nurse and client sitting at a 90-degree angle to each other. The client sitting in a chair and the nurse standing a few feet away. The nurse and client sitting facing each other.

The nurse and client sitting at a 90-degree angle to each other. This arrangement allows the nurse to observe the client but places no barriers between the principals. The two are at the same height, so neither is in an inferior position. Face-to-face seating is a more confrontational arrangement and therefore more anxiety producing.REF: 150

When preparing to hold an admission interview with a client, the nurse pulls up a chair and sits facing the client with his or her knees almost touching. When the nurse leans in close to speak, the client becomes visibly flustered and gets up and leaves the room. What is the most likely explanation for client's behavior? The nurse violated the client's personal space by physically being too close. The client has issues with sharing personal information. The nurse failed to explain the purpose of the admission interview. The client is responding to the voices by ending the conversation

The nurse violated the client's personal space by physically being too close. By sitting and leaning in so closely, the nurse has entered into intimate space (0 to 18 inches), rather than social distance. This has likely made the patient may feel uncomfortable with being so close to someone unknown to them. All the other options lack evidence and jump to conclusions regarding the patient's behavior.DIF: Cognitive Level: Analyze (Analysis)REF: page 34TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity

What is the focus during clinical supervision? The nurse's behavior in the nurse-client relationship Analysis of the client's motivation for transferences Devising alternative strategies for client growth Assisting the client to develop increased independence

The nurse's behavior in the nurse-client relationship Clinical supervision helps the nurse look at his or her own behavior and determine more effective approaches to working with clients. None of the other options are associated with clinical supervision.REF: 151

The family consists of the husband and his wife, their four children, the wife's 21-year-old sister, and client's elderly aunt. Which members are considered the client's nuclear family? The parents and their four children The wife and her sister The husband and his aunt The four children and the wife's sister

The parents and their four children The term nuclear family refers to parents and the children under the parents' care.REF: 622

A 55-year-old patient recently came to the United States from England on a work visa. The patient was admitted for severe depression following the death of a life partner weeks ago. While discussing the death and its effects the patient shows little emotion. Which of the following explanations is most plausible for this lack of emotion? The patient in denial. The response may reflect cultural norms. The response may reflect personal guilt. The patient may have an antisocial personality.

The response may reflect cultural norms. Showing little emotion while in distress may be a cultural phenomenon. Some cultures, such as the British and German cultures, tend to value highly the concept of self-control and may show little facial emotion in the presence of emotional turmoil. There is no evidence to suggest the patient's lack of emotion is a result of any of the other options.DIF: Cognitive Level: Analyze (Analysis)REF: page 9TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity

When a nurse and client meet informally or have an otherwise limited but helpful relationship, what term is used to identify this relationship? Crisis intervention Therapeutic encounter Autonomous interaction Preorientation phenomenon

Therapeutic encounter A therapeutic encounter is a short but helpful interaction between the nurse and client. None of the other options reflect this form of relationship.REF: 126-127

The client makes the decision to sit about 5 feet away from the nurse during the assessment interview. The nurse can accurately make what assumption about the client's perception of the nurse? The nurse is a safe person to interact with. The nurse is a new friend. They view the nurse as a stranger. They view the nurse as a peer.

They view the nurse as a stranger. Social distance (4-12 feet) is reserved for strangers or acquaintances. This is often the client's perception of staff during the initial phase of relationship-building. This behavior is not associated with any perception provided by any other option.REF: Page 151

It is not always guaranteed that all clients who are voluntarily admitted to a behavioral health unit will have the right to which privilege? Refusal of treatment. To send and receive mail. To seek legal counsel. To access all personal possessions.

To access all personal possessions. A client has the right to keep personal belongings unless they are dangerous. Items such as sharp objects, glass containers, and medication are usually removed from the client's possession and kept in a locked area to be used by the client under supervision or returned at discharge. The remaining options are civil rights afforded to all clients.REF: 69-70

The client disagrees that her husband should seek a promotion since it will require the family to move. After she discusses the situation with their 12-year-old, the child tells her father she does not want to move. The client has engaged in which form of dysfunction family dynamics? Triangulation Enmeshment A double bind Diffuse boundaries

Triangulation Triangulation occurs when a two-person relationship is under stress and one person draws in a third person to stabilize the system by forming a coalition.REF: 626; Box 35-2

A nurse works with a nuclear family that includes an adult child diagnosed with schizophrenia. The child's mother confides that she and her husband "have not been getting along well." She states that her teenage daughter provides much support to her and claims that "she doesn't really like her dad much anymore and doesn't talk to him." The nurse suspects that the family is experiencing which family dysfunctional dynamic? Emotional abuse Neglect Boundary blurring Triangulation

Triangulation Triangulation refers to a family "triangle" of three. When the tension in a dyad (two people) builds, a third person (child, friend, or parent) may be brought in by one of the members. This third person of the dyad serves to help lower the tension by solving the crisis or offering understanding. Family triangles may create emotional instability in the long run and are not optimal for dealing with problems in an open and direct way. There is nothing that indicates abuse. There is nothing to indicate neglect. Boundary blurring occurs when boundaries are diffuse, or unclear.DIF: Cognitive Level: Analyze (Analysis)REF: page 15TOP: Nursing Process: DiagnosisMSC: NCLEX: Psychosocial Integrity

What is the primary difference between a social and a therapeutic relationship? Type of information exchanged Amount of satisfaction felt Type of responsibility involved Amount of emotion invested

Type of responsibility involved In a therapeutic relationship the nurse assumes responsibility for focusing the relationship on the client's needs, facilitating communication, assisting the client with problem-solving, and helping the client identify and test alternative coping strategies.REF: 127-128

What therapeutic communication technique is the nurse using by asking a newly admitted patient, "Please tell me what was happening that led to your hospitalization here?" Using a minimal encourager Using an open-ended question Paraphrasing Reflecting

Using an open-ended question Open-ended questions require more than one-word answers. This question encourages the patient to provide a narrative concerning the circumstances surrounding the need for admission.REF: 143

At what point would the nurse expect a family to demonstrate the greatest dislocation in the family life cycle? When the couple is deciding whether to have children When the first child enters school When a member is diagnosed with multiple sclerosis When the couple renegotiates the marital system as a dyad

When a member is diagnosed with multiple sclerosis Family stress is often the greatest at times of serious illness, death, or divorce. While the other options can produce levels of stress, none are as stressful as coping with a family member's chronic illness.REF: 627

The primary source for data collection during a psychiatric nursing assessment is the client's own words and actions. client's family and friends. client's nonverbal responses. client's medical treatment records.

client's own words and actions. The client should always be considered the primary data source. At times, however, the client will be unable to fulfill this role.REF: 111

A client states "That nurse never seems comfortable being with me." The nurse can be described as not seeming genuine to the client. transmitting fear of clients. unfriendly and aloof. controlling.

not seeming genuine to the client. Hiding behind a role, using stiff or formal interactions, and creating distance between self and client suggest a nurse is lacking in genuineness, or the ability to interact in a person-to-person fashion. This characteristic is not associated with the other options.REF: 126-127, 133