Exam 2

Which self-reflective question is directed towards understanding the fundamental basis of personal attitudes about people of diverse cultures?

While a child, what attitudes did your family express about other cultures?

In a nontherapeutic relationship, a client may respond by

Leaving the unit and not be available for the scheduled meeting

Which statement by the nurse demonstrates acceptable to the client who has made a sexually inappropriate comment?

"Our relationship is one of a professional nature"

A nurse has approached a new client on the psychiatric care unit in order to establish a therapeutic relationship and conduct a focused assessment. As the nurse approaches the client, the client says, "Oh good. Here comes one more person to tell me that I'm crazy." Which of the nurse's following responses would constitute countertransference?

"There's no need to get rude with me. I'm just trying to do my job and help you out."

Of the following items, which should the nurse discuss with the client about what the client's responsibilities are doing the first meeting? ~Select all that apply~

- Attendance is expected for each session - Participation is expected during each session

A nurse knows rapport has been established when the client ~select all that apply~

- Develops a sense of sharing - Displays decreased anxiety and feels comfortable in the presence of the nurse

A nurse and client are in orientation phase of the nurse-client relationship. Which of the following behaviors would occur during this phase? ~select all that apply~

- Explanation of the purpose of the relationship - Discussion of the client's expectations - Reviewing the client history

A nurse is engaged in therapeutic nurse-client relationship. The relationship is in the working phase. With which of the following would the client be involved? ~select all that apply~

- Testing new ways for problem solving - Discussing problems related to needs - Examining personal issues

The middle phase of a deteriorating relationship usually consists of which of the following? ~select all that apply~

- The client trying to avoid the nurse - The nurse ignoring and avoiding the client's requests for help

The third phase of the therapeutic relationship is often when the client

Acts like he is looking for a fight

Which role of the nurse-client relationship is being exhibited when the nurse informs the client and then supports him/her in whatever decision her/she makes?

Advocate

Which element would be present in an assertive community treatment (ACT) program? A) 24-hour-a-day services B) Infrequent contact with clients C) Many clients to each staff member D) Limited length of service

Ans: A Feedback: ACT includes a 24-hour-a-day service, many staff members for each client, in-home or community services, intense and frequent contact, and unlimited length of service.

A nurse is orienting to a new position working the infirmary in the state penitentiary. When working with prisoners who are also mentally ill, the nurse examines her own attitudes. Which of the following beliefs should the nurse discuss with her supervisor before caring for incarcerated patients? A) People with mental illness are inherently violent. B) The mentally ill can get better treatment in prison than in the community. C) People with mental illness are more vulnerable to victimization when incarcerated. D) Many mentally ill would not be in prison if they were stabilized on medication.

Ans: A Feedback: Although it is true that people with major mental illnesses who do not take prescribed medication are at increased risk for being violent, most people with mental illness do not represent a significant danger to others. Criminalization of mental illness refers to the practice of arresting and prosecuting mentally ill offenders, even for misdemeanors, at a rate four times that of the general population in an effort to contain them in some type of institution where they might receive needed treatment. People with a mental illness are more likely to be the victims of violence, both in prisons and in the community.

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

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

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

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

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

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

What is an important role of the nurse with regard to residents opposing plans to establish a group home or residential facility in their neighborhood? A) To provide information to correct misinformation related to stereotypes of persons with mental illnesses B) To persuade neighborhood residents that mentally ill people need safe, affordable, and desirable housing C) To provide for the safety and security of the neighborhood D) To ensure the security of persons in the group home

Ans: A Feedback: Frequently, residents oppose plans to establish a group home or residential facility in their neighborhood. They argue that having a group home will decrease their property values, and they may believe that people with mental illness are violent, will act bizarrely in public, or will be a menace to their children. These people have strongly ingrained stereotypes and a great deal of misinformation. Local residents must be given the facts, and nurses are in a position to advocate for clients by educating members of the community. The neighborhood residents who object to the establishment of a group home or residential setting may not be motivated to understand the needs of mentally ill people. It is not the responsibility for the nurse to provide for the safety and security of the neighborhood or protect the safety and security of persons in the group home.

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

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

A patient with bipolar disorder has a long history of both hospitalizations and incarcerations. The patient has no permanent residence and has infrequent contact with his family. Upon admission to the inpatient psychiatric unit for stabilization, the nurse documents all of the following in the record. Which of the following data most suggests a positive outcome for this patient? A) Reporting meeting with the same case manager monthly for the last 3 years B) History of residential stays at several local homeless shelters C) Last contact with siblings 4 years ago D) Income from day labor for 10 days last month

Ans: A Feedback: Results are positive when personal connections with case managers are established. The most recent report from the ACCESS project found frequent shifts between the street, programs, and institutions worsen the lives of the homeless. The degree of social support and employment has direct influence on quality of life.

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

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

Which type of psychiatric rehabilitation relies on intentional communities and rehabilitation alliances? A) Clubhouse model B) Assertive community treatment C) Group homes D) Respite housing

Ans: A Feedback: The clubhouse model of psychiatric rehabilitation relies on intentional communities and rehabilitation alliances. Assertiveness community treatment (ACT) has a problem- solving orientation, and staff members who are in the community attend to specific life issues of the client. Group homes are a residential form of treatment for mental illness but do not provide complete psychiatric rehabilitation. Respite housing is temporary housing for mentally ill persons and does not provide complete psychiatric rehabilitation.

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

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

A patient with bipolar disorder taking lithium returns from a walk outside and reports feeling shaky and dizzy. The nurse suspects the patient is experiencing a toxic reaction to the lithium and immediately notifies the A) psychiatrist. B) psychologist. C) nurse manager. D) recreation therapist.

Ans: A Feedback: The primary function of the psychiatrist is diagnosis of mental disorders and prescription of medical treatments. Psychologists participate in the design of therapy programs for groups of individuals. The nurse is an essential team member in evaluating the effectiveness of medical treatment particularly medications. The recreation therapist helps the client to achieve a balance of work and play.

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

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

What are the two essential components of transitional care discharge model that is used in Canada and Scotland? A) Peer support and bridging staff B) Collaboration and funding C) Relapse and hospitalization D) Poverty and entitlements

Ans: A Feedback: Two essential components of the transitional care discharge model are peer support and bridging staff. Peer support is provided by a consumer now living successfully in the community. Bridging staff refers to an overlap between hospital and community care hospital staff do not terminate their therapeutic relationship with the client until a therapeutic relationship has been established with the community care provider. This model requires collaboration, administrative support, and adequate funding to effectively promote the patient's health and well-being and prevent relapse and rehospitalization. Poverty among people with mental illness is a significant barrier to maintaining housing. Mentally ill persons often rely on government entitlements for their income which forces people to have to choose continuation of the entitlement and dependence versus working inconsistently in unskilled, part-time, and low-paying jobs with no health insurance.

Patient says to the nurse, "I wonder what's playing at the movie tonight." The most therapeutic response would be, A) Are you telling me you would like to go to the movies? B) Why don't you look in the newspaper. C) There's nothing worth watching. D) Do you like to go to the movies?

Ans: A Feedback: Verbalizing the implied/voicing what the client has hinted at or suggested. Putting into words what the client has implied or said indirectly tends to make the discussion less obscure. The nurse should be as direct as possible without being unfeelingly blunt or obtuse. The client may have difficulty communicating directly. The nurse should take care to express only what is fairly obvious; otherwise, the nurse may be jumping to conclusions or interpreting the client's communication.

The factor having the most influence on the current trend in treatment settings is the fact in recent years, A) funding for community programs has been inadequate. B) laws have enabled more people to be committed to treatment. C) state hospitals have expanded to meet the demand. D) community programs have been fully developed to meet treatment needs.

Ans: A Feedback: Adequate funding has not kept pace with the need for community programs and treatment. Commitment laws have led to deinstitutionalization. Large state hospitals emptied as a result. Treatment in the community was intended to replace much of state hospital inpatient care, but funding has been inadequate.

What is required for a transitional care model to be most effective in promoting the client's health and well-being and prevent relapse and rehospitalization? Select all that apply. A) Collaboration B) Administrative support C) Adequate funding D) Family support E) Completely different providers F) Isolation from peers who successfully live in the community

Ans: A, B, C Feedback: Two essential components of transitional care model are peer support and bridging staff. Peer support is provided by a consumer now living successfully in the community. Bridging staff refers to an overlap between hospital and community careóhospital staff do not terminate their therapeutic relationship with the client until a therapeutic relationship has been established with the community care provider. This model requires collaboration, administrative support, and adequate funding to effectively promote the patient's health and well-being and prevent relapse and rehospitalization.

Which of the following are core skill areas that are needed of any effective team member of an interdisciplinary team? Select all that apply. A) Interpersonal skills B) Teamwork skills C) Communication skills D) The ability to work independently E) Risk assessment and risk management skills

Ans: A, B, C, E Feedback: The core skill areas that are needed to function as an effective team member of an interdisciplinary team include interpersonal skills, such as tolerance, patience, and understanding; humanity, such as warmth, acceptance, empathy, genuineness, and nonjudgmental attitude; knowledge base about mental disorders, symptoms, and behavior; communication skills; personal qualities, such as consistency, assertiveness, and problem-solving abilities; teamwork skills, such as collaborating, sharing, and integrating; risk assessment and risk management skills. Members of an interdisciplinary group must work interdependently, not independently.

Discharge planning from inpatient care for people with severe mental illness must address which of the following to be effective? Select all that apply. A) Finding housing for the client B) Finding a job for the client C) Finding transportation for the client D) Improving family support E) Identifying ideal recreational activities

Ans: A, C Feedback: Clinicians help clients recognize symptoms, identify coping skills, and choose discharge supports in the inpatient setting. People are able to remain in the community for longer periods of time when discharge planning addresses environmental supports, housing, transportation, and access to community support services. Finding a job for the client may be helpful if appropriate but may not be appropriate for the individual at the time of discharge from inpatient care. Improving family support and identifying ideal recreational activities are desirable but not essential for successful reintegration with the community.

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

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

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

Ans: A, C, D Feedback: Clients who lose cognitive processing, such as those who are anxious, cognitively impaired, or suffering from some mental disorders, often function at a concrete level of comprehension and have difficulty answering abstract questions. The nurse must be sure that statements and questions are clear and concrete.

A patient has just begun daily participation in a community-based partial hospitalization program. The patient can expect the staff to assist with which of the following treatment goals? Select all that apply. A) Stabilizing psychiatric symptoms B) Finding a better job C) Improving activities of daily living D) Learning to structure time E) Improved family support F) Developing social skills

Ans: A, C, D, F Feedback: Partial hospitalization programs are designed to help clients make a gradual transition from being inpatients to living independently and to prevent repeat admissions. In day treatment programs, clients return to home at night; evening programs are just the reverse. Partial hospitalization programs provide assistance with stabilizing psychiatric symptoms, monitoring drug effectiveness, stabilizing living environment, improving activities of daily living, learning to structure time, developing social skills, obtaining meaningful work, paid employment, or a volunteer position, and providing follow-up of any health concerns. Finding a better job and improving family support are not goals of partial hospitalization programs.

A patient is being transferred from a group home to an evolving consumer household. The goal of this transition is for the patient to eventually A) meet with a therapist on a weekly basis. B) resolve crises within a shorter time period. C) fulfill daily responsibilities without supervision. D) use the increased emotional support of paid staff.

Ans: C Feedback: The evolving consumer household is a group-living situation in which the residents make the transition from a traditional group home to a residence where they fulfill their own responsibilities and function without onsite supervision from paid staff.

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

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

The primary advantage of an evolving consumer household is that clients A) are provided with adequate income to combat poverty. B) do not have to relocate as they become more independent. C) have on-site staff supervision 24 hours a day. D) receive on-site medical care.

Ans: B Feedback: An evolving consumer household is a permanent living situation, eliminating the need to change residential settings as clients gain independence. Many clients in evolving consumer households rely on Social Security Insurance or Social Security Disability Insurance. Clients function without onsite supervision

The patient expresses frustration that the doctor does not spend enough time with the patient when making rounds. The nurse replies, "The doctors are very busy. What can I help you with?" The nurse incorporated which nontherapeutic technique in this response? A) Belittling B) Defending C) Disagreeing D) Introducing an unrelated topic

Ans: B Feedback: Defending attempts to protect someone or something from verbal attack. This implies that the client has no right to express impressions, opinions, or feelings. Belittling is misjudging the degree of the client's discomfort, which implies that the discomfort is temporary, mild, self-limiting, or not very important. Disagreeing is opposing the client's ideas, which may cause the client to feel defensive about his or her point of view or ideas. Introducing an unrelated topic is evidenced when the nurse changes the subject. This takes away the initiative for the client to interact.

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

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

A patient is sitting alone, slouched, with eyes closed. The nurse approaches. Which statement is most likely to encourage the patient to talk? A) If you are sleepy, would you like me to help you back to your room? B) You look like you are deep in thought? C) Is something wrong? D) Why are you sitting with your eyes closed?

Ans: B Feedback: Making observations/verbalizing what the nurse perceives. Sometimes clients cannot verbalize or make themselves understood. Or the client may not be ready to talk.

Which of the following factors is primarily responsible for the changes in inpatient hospital treatment between the 1980s and the present? A) Progress in treatment options for mentally ill persons B) The growth of managed care C) Less stigma associated with mental illness D) The current use of milieu therapy

Ans: B Feedback: Managed care exerts cost-control measures such as recertification of admissions, utilization review, and case management--all of which have altered inpatient treatment significantly. There has been some progress in treatment options for mentally ill persons, but that is not the primary factor that has changed mental health inpatient hospital care. There is lesser stigma associated with mental illness, but that is not the primary factor that has changed mental health inpatient hospital care. In the 1980s, a typical psychiatric unit emphasized milieu therapy, which required long lengths of stay because clients with more stable conditions helped to provide structure and support for newly admitted clients with more acute conditions.

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

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

A psychiatric nurse is planning an educational program addressing primary prevention strategies in the community. The nurse explores current research regarding which health-care need? A) Influencing schizophrenic patients to adhere to medication regimens B) Assisting high school students to effectively manage stress C) Coaching patients with depression to obtain employment D) Teaching parents the early signs of attention deficit disorder in children

Ans: B Feedback: Nurses work to provide mental health prevention services to reduce risks to the mental health of persons, families, and communities. Examples include primary prevention, such as stress management education; secondary prevention, such as early identification of potential mental health problems; and tertiary prevention, such as monitoring and coordinating rehabilitation services for the mentally ill.

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

Ans: B Feedback: The intimate zone is the amount of space that is comfortable for parents with young children and those who desire personal contact. The social zone is the distance acceptable for communication in social, work, and business settings. The personal zone is comfortable between family and friends who are talking. The public zone is an acceptable distance between a speaker and an audience.

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

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

A patient is encouraged to join in daily outdoor games with peers on the unit. The interdisciplinary team member who will monitor the patient's involvement will be the A) occupational therapist. B) recreation therapist. C) vocational rehabilitation therapist. D) psychiatric nurse.

Ans: B Feedback: The recreation therapist helps the client to achieve a balance of work and play in his or her life and provides activities that promote constructive use of leisure or unstructured time. Occupational therapy focuses on the functional abilities of the client and ways to improve client functioning. Vocational rehabilitation includes determining clients' interests and abilities and matching them with vocational choices. The nurse has a solid foundation in health promotion, illness prevention, and rehabilitation in all areas, allowing him or her to view the client holistically. The nurse is also an essential team member in evaluating the effectiveness of medical treatment, particularly medications.

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

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

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

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

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

Ans: B Feedback: When the nurse states, "It would be unusual for anyone to have that kind of power," the nurse is voicing doubt or expressing uncertainty about the reality of the client's perceptions. The other choices have demeaning connotations toward the client and should not be used

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

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

Which of the following are advantages of a crisis resolution team or home treatment team? Select all that apply. B) It is more likely to help a client to perceive his or her situation more accurately. C) It is designed to assist clients in dealing with mental health crises without hospitalization. D) The client may feel better about asking for help.

Ans: B, C, D Feedback: Crisis resolution or respite care is a type of care for clients who have a perception of being in crisis and needing a more structured environment. A client having access to respite services is more likely to perceive his or her situation more accurately, feel better about asking for help, and avoid hospitalization

A patient has just been referred to a psychosocial rehabilitation program. The nurse explains that the benefits of being involved in such a program include: Select all that apply. A) continuous monitoring of symptoms. B) increased independence. C) increased involvement in treatment decisions. D) recovery from mental illness. E) increased community integration. F) greater opportunities for personal growth.

Ans: B, D, E Feedback: Goals of psychosocial rehabilitation programs include recovery from mental illness, personal growth, quality of life, community reintegration, empowerment, increased independence, decreased hospital admissions, improved social functioning, improved vocational functioning, continuous treatment, increased involvement in treatment decisions, improved physical health, and a recovered sense of self. Monitoring of symptoms and medication education are major foci of partial hospitalization programs

A patient remarks, "You know, it's the same thing every time." The nurse should respond by stating, A) I understand. B) I'm sure everyone is doing their best. C) I'm not sure what you mean. Please explain. D) It's the same thing every time?

Ans: C Feedback: Consensual validation-searching for mutual understanding, for accord in the meaning of the words. For verbal communication to be meaningful, it is essential that the words being used have the same meaning for both (all) participants. Sometimes, words, phrases, or slang terms have different meanings and can be easily misunderstood.

A nurse is meeting with the city council to advocate for mentally ill persons and the establishment of a group home in a neighborhood where the plans have been strongly opposed by the neighbors. The nurse can effectively educate the public on the realities of group home by citing research that indicates A) property values quickly rebound in neighborhoods that have group homes. B) police surveillance will be increased to avert any violence by residents. C) most people with mental illness do not represent a significant danger to others. D) neighborhoods that provide park areas provide children a centralized and safe place to play.

Ans: C Feedback: Frequently, residents oppose plans to establish a group home in their neighborhood, arguing that having a group home will decrease their property values, and they may believe that people with mental illness are violent, will act bizarrely in public, or will be a menace to their children. These people have strongly ingrained stereotypes and a great deal of misinformation

A nurse documents that a patient has successfully acquired a job performing janitorial services at a local manufacturing company. The goal of which of the following levels of prevention has been achieved? A) Primary prevention B) Secondary prevention C) Tertiary prevention D) Community prevention

Ans: C Feedback: Nurses work to provide mental health prevention services to reduce risks to the mental health of persons, families, and communities. Examples include primary prevention, such as stress management education; secondary prevention, such as early identification of potential mental health problems; and tertiary prevention, such as monitoring and coordinating rehabilitation services for the mentally ill.

The primary goal of a psychiatric rehabilitation program is to promote A) return to prior level of functioning. B) medication compliance. C) complete recovery from mental illness. D) stabilization and management of symptoms.

Ans: C Feedback: Psychiatric rehabilitation goes beyond management of symptoms and medication management to include personal growth, reintegration into the community, empowerment, increased independence, and improved quality of life. It is not a goal of psychiatric rehabilitation to return to the prior level of functioning that may have been dysfunctional. It may not be realistic for the client to completely recover from mental illness, but rehabilitation can improve the quality of life for the client.

Which of the following is the highest priority for admission to inpatient care? A) Confusion or disorientation B) Need for medication changes C) Safety of self or others D) Withdrawal from alcohol or other drugs

Ans: C Feedback: Safety is a priority; the inpatient setting provides for the safety of the client and/or others. Confusion or disorientation, need for medication changes, and withdrawal from alcohol or other drugs may also require inpatient care but the priority is safety.

A patient has been started on antidepressants. The interdisciplinary team member most responsible for monitoring effectiveness and side effects of this new medication is the A) pharmacist. B) psychiatrist. C) psychiatric nurse. D) psychologist.

Ans: C Feedback: The nurse is also an essential team member in evaluating the effectiveness of medical treatment, particularly medications. The pharmacist has a working knowledge of medications but has limited contact with the patient. The primary function of the psychiatrist is diagnosis of mental disorders and prescription of medical treatments. The clinical psychologist practices therapy.

A patient asks the nurse what she should do about her "cheating" husband. The nurse replies, "You should divorce him. You deserve better than that." The nurse used which communication technique? A) Giving information B) Verbalizing the implied C) Giving advice D) Agreeing

Ans: C Feedback: The nurse should not give advice, or tell the patient what to do. Advising implies that only the nurse knows what is best for the client. Giving information is therapeutic when the patient needs facts. Verbalizing the implied is a therapeutic communication technique which involves putting clearly into words what the patient has suggested. Verbalizing tends to make the discussion less obscure. Agreeing, or giving approval, indicates the patient is right or wrong. Nurses should remain neutral when using therapeutic communication skills.

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

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

During the mental status assessment, the client expresses the belief that the CIA is stalking him and plans to kidnap him. The best response by the nurse would be, A) That makes no sense at all. B) You can tell me about that after I finish asking these questions. C) What kinds of things have been happening? D) Why would the CIA be interested in you?

Ans: C Feedback: When the nurse responds, "What kinds of things have been happening?" the nurse is seeking information. "That makes no sense at all," is inappropriate because it may make perfect sense to the client. "You can tell me about that after I finish asking these questions," shows that the nurse is not interested in what the client has to say. "Why would the CIA be interested in you," feeds into the notion that the CIA is stalking the client.

A patient who has continuously experienced severe symptoms of schizoaffective disorder for the past 17 years is experiencing an acute psychotic episode. Which level of care is most appropriate for this patient at this time? A) Partial hospitalization B) Residential treatment C) Inpatient hospital treatment D) Clubhouse

Ans: C Feedback: Long-stay clients in an inpatient setting are people with severe and persistent mental illness who continue to require acute care services despite the current emphasis on decreased hospital stays. This population includes clients who were hospitalized before deinstitutionalization and remain hospitalized despite efforts at community placement. It also includes clients who have been hospitalized consistently for long periods despite efforts to minimize their hospital stays. Partial hospitalization is designed for patients transitioning to independent living. Residential treatment and clubhouse model provide supervised independent living.

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

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

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

Ans: D Feedback: A quiet corner of the dayroom at least 4 feet away from others would allow the patient privacy while being to deter any inappropriate activity would be the most appropriate setting. Being in the patient's room when the patient's roommate is present and 3 feet away or at the nurse's station when other patients and visitors are less than 4 feet away would not allow for the patient's privacy. An interview room in a remote section of the unit would not be a good choice as the area is too isolated. Additionally, the nurse should maintain a distance of more than 1.5 feet away from the patient as closer distances are within the intimate zone

Which is the orientation of assertive community treatment (ACT)? A) Setting limits on mundane life issues B) Making a wide range of referrals C) Providing services in offices D) Problem-solving orientation

Ans: D Feedback: An ACT program has a problem-solving orientation: Staff members attend to specific life issues, no matter how mundane. ACT programs provide most services directly rather than relying on referrals to other programs or agencies, and they implement the services in the clients' homes or communities, not in offices.

Which type of community residential treatment setting is most likely to be permanent in any state? A) Halfway house B) Respite housing C) Independent living programs D) Evolving consumer household

Ans: D Feedback: Because the evolving consumer household is a permanent living arrangement, it eliminates the problem of relocation. Halfway houses usually serve as temporary placements that provide support as the clients prepare for independence. Clients who are served by respite housing are those who live in group homes or independently most of the time but have a need for "respite" from their usual residences when the client experiences a crisis, feels overwhelmed, or cannot cope with problems or emotions. Independent living programs are available in many states, but may vary a great deal in regard to services provided with some agencies providing a broad range of services or shelter but few services.

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

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

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

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

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

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

The nurse is part of a group setting up a mobile crisis service in conjunction with the local police department. Community education on which of the following this team will focus includes? A) Teaching police officers counseling skills B) Crisis counseling services to be provided in the prison system C) Educating about the dangers of the mentally ill in the community D) Assisting police officers to recognize mental illness

Ans: D Feedback: Mobile crisis services are linked to police departments. These professionals are called to the scene when police officers believe mental health issues are involved. Frequently, the mentally ill individual can be diverted to crisis counseling services or to the hospital, if needed, instead of being arrested and going to jail. Often, these same professionals provide education to police to help them recognize mental illness and perhaps change their attitude about mentally ill offenders. They do not provide direct counseling training to police officers.

A psychiatric nurse is planning activities aimed at secondary prevention of mental illness. Which activity would be most appropriate to develop? A) Self-esteem building with a local after-school program B) Social skills training for chronic schizophrenics C) Parenthood classes at a local community center D) Depression screening in an assisted living facility

Ans: D Feedback: Nurses work to provide mental health prevention services to reduce risks to the mental health of persons, families, and communities. Examples include primary prevention, such as stress management education; secondary prevention, such as early identification of potential mental health problems; and tertiary prevention, such as monitoring and coordinating rehabilitation services for the mentally ill.

The priority of inpatient care for people with severe mental illness is A) family issues. B) insight into illness. C) social skills. D) symptom management.

Ans: D Feedback: Rapid assessment, stabilization of symptoms, and discharge planning are the focus of inpatient care today. Family issues, insight into illness, and social skills would not be priorities of care for clients with severe mental illness

A patient yells, "All the nurses here are so mean. None of you really care about us!" The most therapeutic response would be, A) "I cannot allow you to yell like that." B) "We care about you." C) "Oh, really?" D) "You seem very irritated."

Ans: D Feedback: Reflecting/directing client actions, thoughts, and feelings back to client. Reflection encourages the client to recognize and accept his or her own feelings. The nurse indicates that the client's point of view has value and that the client has the right to have opinions, make decisions, and think independently.

The nurse asks the patient, "What was it like for you when you first knew you had no place to go?" The patient looks down and pauses for quite some time. Which action by the nurse is most therapeutic? A) Change the subject to something the patient will discuss B) Encourage the patient to express any unpleasant feelings C) Apologize for asking such a personal question D) Sit quietly until the patient responds

Ans: D Feedback: Silence or long pauses in communication may indicate many different things. The client may be depressed and struggling to find the energy to talk. Sometimes pauses indicate the client is thoughtfully considering the question before responding. At times, the client may seem to be "lost in his or her own thoughts" and not paying attention to the nurse. It is important to allow the client sufficient time to respond, even if it seems like a long time.

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

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

The nurse is trying to obtain some information about family relationships from the client. Which of the following statements is best? A) Is it upsetting for you to talk about your family? B) Is your family ready for you to come home? C) So, how is your family? D) Tell me your feelings about your family situation.

Ans: D Feedback: This statement asks the client to describe or discuss family; all other statements might get only one-word answers

Some residential treatment settings are transitional. This means that clients are eventually expected to A) become self-sufficient. B) find employment. C) no longer need medication. D) relocate to another setting.

Ans: D Feedback: Transitional housing is temporary; clients are expected to move to another residential setting. Clients using transitional treatment settings are not expected to become totally self-sufficient, find employment, or not be in need of medication.

A patient with depression is admitted to an inpatient hospital unit for treatment. The type of therapy most likely provided in this setting includes A) leisure skills. B) self-monitoring of treatment. C) skills for daily living. D) talk therapy.

Ans: D Feedback: A typical psychiatric unit emphasizes talk therapy, or one-on-one interactions between residents and staff, and milieu therapy, meaning the total environment and its effect on the client's treatment. Partial hospitalization programs teach skills for daily living. Clubhouse models provide patients opportunities for leisure activities and self- monitoring of treatment.

Which of the following is not considered a step in the values clarification process?

Assessing

Which of the following terms is used to describe general feelings or a frame of reference around which a person organizes knowledge about the world?

Attitudes

A nurse engaged in self-awareness has come to understand his own personal beliefs and attitudes, and has recognized some prejudicial ideas. Based on this understanding, which of the following would the nurse now be able to accomplish?

Change learned behaviors

Which of the following occurs when the nurse responds to the client based on personal unconscious needs and conflicts?

Countertransference

What occurs during the working phase of the nurse-client relationship?

Evaluation of mutually identified goals

Which nursing intervention demonstrates congruence in a therapeutic nurse-client relationship?

Getting an appointment with the client at the time previously agreed upon

What activity should be included in the first step of self-reflection?

Identifying one's own values, attitudes, strengths and weakness

Which of the following actions by the nurse or client represents the working phase of the therapeutic relationship?

Identifying past ineffective behaviors

Which of the following is an inaccurate statement regarding a preconception?

It enables the nurse to get an accurate picture of the client's problems

When the medical health nurse helps the cognitively impaired client bathe and dress herself, the rose being assumed is

Mother surrogate

It is the nurse's responsibility to define the boundaries of the relationship during which phase of the nurse-client relationship?

Orientation

Which of the following would be considered a "usual or expected" response during the first few sessions?

Rambling due to nervousness

A psychiatric-mental health nurse recognizes the importance of reflecting thoughtfully and critically on the feelings experienced when interacting with patients. This practice of self-reflection will most likely produce what benefit?

Reduced likelihood of developing empathic linkages

All except which of the following are goals of the working phase of the therapeutic relationship?

Reducing the client's anxieties

During the orientation phase of the nurse-client relationship, the client is involved with which of the following?

Seeking assistance

A nursing instructor is describing the nurse-client relationship to a group of nursing students. Which of the following would the instructor emphasize as crucial for establishing a maintaining the relationship?

Self-awareness

What should the nurse avoid when demonstrating genuine interest for a client by making a self-disclosure?

Shifting the emphasis to the nurse

A client is talking to a nurse about the recent death of her grandmother. She is sad, and tears roll down her cheeks as she talks. The nurse remembers how she felt when her own grandmother died the previous summer. The nurse puts her hand on the client's shoulder and says, "This must be very difficult for you." The nurse is demonstrating empathy based on which of the following?

The nurse's response reflects an attempt to communicate understanding of the client's feelings

The nurse-client relationship is classified as which type of relationship?

Therapeutic