Exam 4 Recommended NCLEX Qs.

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

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

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

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

A nursing instructor is teaching about dichotomous thinking. Which student statement indicates that learning has occurred? A. "Dichotomous thinking is when an individual views situations as being 'good or bad' or 'black or white.'" B. "Dichotomous thinking is when an individual takes complete responsibility for situations without considering other circumstances." C. "Dichotomous thinking is when an individual exaggerates the negative significance of an event." D. "Dichotomous thinking is when an individual undervalues the positive significance of an event."

ANS: A An individual who is using dichotomous thinking views situations in terms of "all or nothing," "good or bad," or "black or white." KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

Using a cognitive approach, a nurse would choose which intervention for assisting clients to manage their anger without the use of violence? A. Assist the client to identify thoughts that trigger anger and substitute reality-based thinking. B. Provide consequences, such as removal from group therapy, in response to angry outbursts. C. Administer antipsychotic medications and use limit-setting such as a room restriction. D. Administer anti-anxiety medication and encourage participation in a group on medication actions.

ANS: A By assisting the client to identify thoughts that trigger anger and encourage the substitution of more reality-based thinking, the nurse can help the client to alter dysfunctional beliefs that predispose the client to distort experiences. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

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

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

Which client statement would exemplify the level of cognitive function that you would expect to see in mild anxiety? A. "Right now I feel as sharp as a tack." B. "I'm having a tough time focusing." C. "Sometimes I feel like I'm having an out-of-body experience." D. "All I seem to focus on is my anger."

ANS: A Cognitive ability will be enhanced with mild anxiety. Mild anxiety prepares the individual for heightened responses to environmental stimuli. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A nurse working for a large corporation is teaching relaxation therapy to employees. Which relaxation technique should the nurse initially teach? A. Deep-breathing exercises B. Mental imagery C. Biofeedback D. Meditation

ANS: A Deep breathing is a simple skill and is basic to other relaxation techniques and therefore should be taught first.

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

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

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

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

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

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

An advanced practice nurse is counseling a client diagnosed with generalized anxiety disorder. The nurse plans to use activity scheduling to address this client's concerns. What is the purpose of this nursing intervention? A. To identify important areas needing concentration during therapy B. To increase self-esteem and decrease feelings of helplessness C. To modify maladaptive behaviors by the use of role-play D. To divert away from intrusive thoughts and depressive ruminations

ANS: A In activity scheduling, the client is asked to keep a daily log of activities and rate them for mastery and pleasure in order to identify recurring daily patterns that may need to be addressed in therapy. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

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

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

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

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

Which action should a nurse take prior to educating clients about relaxation techniques? A. Assisting the client in identifying triggers or sources of stress B. Performing a physical examination to qualify the client as a candidate for this therapy C. Obtaining an order from the physician D. Educating the client's family so they can be active participants in the therapy

ANS: A Initially helping clients to identify triggers and sources of stress will enable the client to anticipate the need for implementing relaxation techniques at appropriate times.

A successful business executive continually thinks that job accomplishments are not adequate. A nurse recognizes that the client's thinking is reflective of which cognitive error? A. Minimization B. Dichotomous thinking C. Arbitrary inference D. Personalization

ANS: A Minimization is the cognitive error that undervalues positive events and experiences. The client cannot give credit for personal strengths. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A community health nurse is planning a health fair at a local shopping mall. Which middle-class socioeconomic cultural group should the nurse anticipate would most value preventive medicine and primary health care? A. Northern European Americans B. Native Americans C. Latino Americans D. African Americans

ANS: A Northern European Americans, especially those who achieve middle-class socioeconomic status, place the most value on preventative medicine and primary health care. This value is most likely related to this group's educational level and financial capability. Many members of the Native American, Latino American, and African American subgroups value folk medicine practices. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A client diagnosed with major depressive disorder refuses to get out of bed. Which nursing statement appropriately educates the client about the benefits of physical activity? A. "Depression is caused by the lack of certain brain chemicals that can increase with exercise." B. "Physical activity is good for everyone regardless of their diagnosis." C. "Low-intensity exercise is more beneficial than high-impact exercise." D. "When you are physically active, it helps to lower your beta endorphins."

ANS: A Physical activity can stimulate the secretion of norepinephrine and serotonin. Depression has been linked to low levels of these neurotransmitters.

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

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

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

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

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

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

After suffering a myocardial infarction, a 37-year-old executive demands premature discharge from the hospital. He tells the nurse, "Just give me my prescriptions and let me get back to work." Which is the most appropriate nursing reply? A. "To ensure improved health, we need to discuss diet, medication, exercise, and lifestyle changes before you are discharged." B. "You will not be allowed to leave the hospital without getting your physician's approval for early discharge." C. "We will discharge you quickly so that the stress you are experiencing will not cause more serious heart damage." D. "Prior to discharge, we will need to discuss job stress, your finances, and the possibility of an early retirement."

ANS: A The client's statements reflect a great deal of stress that can contribute to further cardiovascular disease. Helping him to look at a variety of measures to improve his health would be most beneficial.

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

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

A Native American client is admitted to an emergency department (ED) with an ulcerated toe secondary to uncontrolled diabetes mellitus. The client refuses to talk to a physician unless a shaman is present. Which nursing intervention is most appropriate? A. Assist the client in contacting a shaman of his choice. B. Explain to the client that "voodoo" medicine will not heal the ulcerated toe. C. Ask the client to explain what the shaman can do that the physician cannot. D. Inform the client that refusing treatment is a client's right.

ANS: A The most appropriate nursing intervention would be to facilitate meeting the client's need to have a shaman present. The nurse should understand that in the Native American culture, religion and health-care practices are often intertwined. The shaman, a medicine man, may confer with physicians regarding the care of a client. Research supports the importance of both health-care systems in the overall wellness of Native American clients. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Implementation |Client Need: Psychosocial Integrity

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

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

In what way should a nurse expect a traditional Asian American client to view mental illness? A. Mental illness relates to uncontrolled behaviors that bring shame to the family. B. Mental illness is a curse from God related to immoral behaviors. C. Mental illness is cured by home remedies based on superstitions. D. Mental illness is cured by "hot and cold" herbal remedies.

ANS: A The nurse should expect that traditional Asian Americans are most likely to view mental illness as uncontrolled behavior that brings shame to the family. It is often more acceptable for mental distress to be expressed as physical ailments. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

Which cultural considerations should a nurse identify with Western European Americans? A. They are present-time oriented and perceive the future as God's will. B. They value youth, and older adults are commonly placed in nursing homes. C. They are at high risk for alcoholism due to a genetic predisposition. D. They are future oriented and practice preventive health care.

ANS: A The nurse should identify that most Western European Americans are present oriented and perceive the future as God's will. Older adults are held in positions of respect and are often cared for in the home instead of nursing homes. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

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

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

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

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

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

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

During the first interview with a man from Syria who has just lost his son in a car accident, in sympathy for the man's loss, the female nurse reaches out and hugs him. Which is an accurate evaluation of the nurse's action? A. The nurse's action should be evaluated as unacceptable due to breech of cultural norms. B. The nurse's action should be evaluated as empathetic, encouraging expression of feelings. C. The nurse's action should be evaluated as the technique of offering self. D. The nurse's action should be evaluated as inappropriate due to poor timing.

ANS: A The nurse's action should be evaluated as unacceptable due to breech of cultural norms. During communication, Arab Americans stand close together, maintain steady eye contact, and may touch the other's hand or shoulder but only between members of the same sex. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

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

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

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

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

A Latino American man refuses to acknowledge responsibility for hitting his wife, stating instead, "It's the man's job to keep his wife in line." Which cultural belief may be associated with this client's behavior? A. Traditional Latino American families are male dominated with clear male-female role distinctions. B. Religious tenets of Latino American culture support the use of violence within a marriage. C. Latino American families are female dominated and the mother possesses ultimate authority. D. Marriage dynamics are controlled by dominant females in Latin American families.

ANS: A Traditional Latino American families are male dominated with clear male-female role distinctions and may impact the client's perception about whether or not striking his wife is physical abuse. The nurse should also recognize that cultural beliefs do no exempt one from adhering to state and federal laws with regard to assault and battery. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

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

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

A high school basketball player sustains a serious knee injury and states to the school nurse, "I will never get to college if I don't receive a basketball scholarship." Which nursing reply would assist the student to see a broader range of possibilities? A. "Let's look at the alternatives for funding your college education." B. "I know you are feeling helpless now, but you are looking at this from only one perspective." C. "Can your family afford knee surgery?" D. "You now need to prioritize your academics and not focus on basketball."

ANS: A When the nurse helps the student to see a broader range of possibilities, the nurse is using the cognitive technique of generating alternatives. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A nursing student evaluates her group project partner as irresponsible because of minimal participation in planning. When told of this situation, the nursing instructor plans to use the cognitive technique of "examining the evidence." Which response exemplifies this technique? A. "Let's look at the potential reasons why your partner has not participated." B. "How would you define irresponsibility?" C. "Has it occurred to you that your partner may be working on the project at home?" D. "Are you telling me that you feel totally responsible for this project?"

ANS: A When using the technique of examining the evidence, the student and nurse review automatic thoughts and study the evidence to support or counter the belief. KEY: Cognitive Level: Application | Integrated Processes: Implementation | Client Need: Psychosocial Integrity

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

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

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

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

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

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

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

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

A nurse practitioner uses cognitive therapy with depressed clients. The nurse asks clients to keep a daily record of dysfunctional thoughts. Which of the following are appropriate nursing replies to a client questioning the purpose of this exercise? Select all that apply. A. "The purpose of this exercise is to identify automatic thoughts." B. "The purpose of this exercise is to identify rational alternatives." C. "The purpose of this exercise is to modify cognitive errors." D. "The purpose of this exercise is to eliminate irrational beliefs." E. "The purpose of this exercise is to monitor thoughts related to self-esteem."

ANS: A, B, C In a daily record of dysfunctional thoughts, clients (1) identify automatic thoughts and (2) generate a more rational response. In this way, the tool serves to help them (3) modify or make changes in their thinking. A daily record of dysfunctional thoughts does not eliminate the occurrence of irrational beliefs or monitor thoughts solely related to self-esteem. KEY: Cognitive Level: Application | Integrated Processes: Teaching/Learning | Client Need: Psychosocial Integrity

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

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

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

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

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

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

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

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

A nurse is teaching principles of mental imagery to a group. On which relaxing environments should the nurse appropriately recommend client focus? (Select all that apply.) A. Visualizing the seashore B. Visualizing a snowy cabin C. Driving home from the beach on Sunday evening D. Floating through the air on a cloud E. Lying at home in front of the fireplace

ANS: A, B, D, E Any environment that the client finds relaxing is appropriate. It is unlikely that a client would consider driving home from the beach on Sunday evening to be a relaxing environment.

Which of the following client statements would indicate that teaching about benzodiazepines has been successful? Select all that apply. A. "I can't drink alcohol when taking lorazepam (Ativan)." B. "If I abruptly stop taking buspirone (BuSpar), I may have a seizure." C. "Valium can make me drowsy, so I shouldn't drive for awhile." D. "My new diet cannot include aged cheese or pickled herring." E. "When the fluoxetine (Prozac) begins working, I can stop the alprazolam (Xanax)."

ANS: A, C When a nurse teaches about medications, he or she is using a cognitive approach. A core concept of cognitive theory relates to the mental process of thinking and reasoning. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

A female nurse is caring for a traditional Arab American male client. When planning effective care for this client, the nurse should be aware of which of the following cultural considerations? Select all that apply. A. Limited touch is acceptable only between members of the same sex. B. Conversing individuals of this culture stand far apart and do not make eye contact. C. Devout Muslim men may not shake hands with women. D. The man is the head of the household and women take on a subordinate role. E. In traditional culture, men are responsible for the education of their children.

ANS: A, C, D When planning effective care for this client, the nurse should be aware that limited touch within this culture is acceptable only between members of the same sex, that devout Muslim men may not shake hands with women, and that women are subordinate to the man, who is the head of household. Conversing individuals of this culture stand close together and maintain eye contact. Arab American women are responsible for the education of the children. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

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

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

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

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

A client who has been referred for stress management asks the nurse, "Which one of these relaxation techniques requires reimbursement from my health insurance?" Which is the appropriate nursing reply? A. "Meditation requires reimbursement from health insurance." B. "Biofeedback requires reimbursement from health insurance." C. "Physical exercise requires reimbursement from health insurance." D. "Deep breathing requires reimbursement from health insurance."

ANS: B Biofeedback is costly and would require reimbursement from health insurance. It requires the use of a machine that gives immediate information about the client's physical state and a biofeedback technician to interpret the results.

The director of nursing (DON) sets up a meeting with the newly appointed nurse manager, who, to this point, has done an excellent job. The nurse manager anticipates job termination. What is the best description of the cognitive error being employed by the nurse manager? A. Thinking from an "all-or-nothing" perspective B. Always thinking the worst will occur without considering positive outcomes C. Viewing only selected negative evidence while editing out positive aspects D. Undervaluing the positive significance of an event

ANS: B Catastrophic thinking involves always thinking that the worst will occur without considering the possibility of more likely positive outcomes. The nurse manager has quickly jumped to the conclusion that the meeting will result in job termination. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A nursing instructor is teaching about the didactic aspects of cognitive therapy. Which student statement indicates a deficit in meeting the learning objectives of this content? A. "The therapist provides information about the process of cognitive therapy." B. "The therapist uses guided imagery in an effort to elicit automatic thoughts." C. "The therapist provides information about how cognitive therapy works." D. "The therapist uses reading assignments to reinforce learning."

ANS: B Cognitive therapy prepares the client to become his or her own cognitive therapist. The didactic portion of the therapy provides educational material to reinforce learning about the therapy and how it affects psychiatric disorders. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A nursing instructor is teaching about cultural characteristics. Which statement by the student indicates the need for further instruction? A. "All cultures communicate freely within their group." B. "All cultures embrace light therapeutic touch." C. "All cultures view the importance of timeliness differently." D. "All cultures display biological variations."

ANS: B Not all cultures embrace light therapeutic touch. In the Native American culture, if a hand is offered to another it may be accepted with a light touch; however, in the Asian culture, touching during communication has been historically considered unacceptable. This student statement indicates the need for further instruction. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

A nursing assistant has failed a prerequisite course toward admission to nursing school and states, "I will always be only a nursing assistant and never an RN." Her nursing advisor understands this is an example of which automatic thought? A. Arbitrary inference B. Overgeneralization C. Dichotomous thinking D. Personalization

ANS: B Overgeneralization occurs when sweeping conclusions are made on the basis of one incident. Because the student failed a prerequisite nursing course, the student overgeneralizes that the goal of being an RN will never be attained. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A nurse is teaching a client deep breathing exercises. The client asks, "Why do I need to make that funny shape with my lips when I breathe out?" What is the most appropriate nursing reply? A. "You can actually exhale anyway you like; the lip shape is not important." B. "Pursed lip breathing helps you control the exhalation and helps to keep your airways open." C. "Don't worry about the lip shape; concentrate instead on the pace of your breathing." D. "The shape of the lip decreases the cough and choking reflex."

ANS: B Pursed lip breathing is controlled, allowing for longer exhalation because it is more effective in keeping the airways open.

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

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

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

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

When working with clients of any culture, which action should a nurse avoid? A. Maintaining eye contact, based on cultural norms B. Assuming that all individuals who share a culture or ethnic group are similar C. Supporting the client in participating in cultural and spiritual rituals D. Using an interpreter to clarify communication

ANS: B The nurse should avoid assuming that all individuals who share a culture or ethnic group are similar. This action constitutes stereotyping and must be avoided. Within each culture, many variations and subcultures exist. Clients should be treated as individuals. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

To effectively care for Asian American clients, a nurse should be aware of which cultural norm? A. Obesity and alcoholism are common problems. B. Older people maintain positions of authority within the culture. C. Milk is a staple in the Asian American diet. D. Asian Americans are likely to seek psychiatric help.

ANS: B To effectively care for clients of the Asian American culture, the nurse should be aware that older people in this culture maintain positions of authority. Obesity and alcoholism are low among Asian Americans. Milk is seldom consumed because a majority of Asian Americans are lactose intolerant. In the Asian culture, psychiatric illness is often believed to be out-of-control behavior and would be considered shameful to individuals and families. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

When interviewing a client of a different culture, which of the following questions should a nurse consider asking? Select all that apply. A. Would using perfume products be acceptable? B. Who may be expected to be present during the client interview? C. Should communication patterns be modified to accommodate this client? D. How much eye contact should be made with the client? E. Would hand shaking be acceptable?

ANS: B, C, D, E When interviewing a client from a different culture, the nurse should consider who might be with the client during the interview, modifications of communication patterns, amount of eye contact, and hand-shaking acceptability, since these are cultural variables. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A nursing instructor is lecturing about cognitive therapy. Which of the following are objectives when implementing this therapy? Select all that apply. A. To modify automatic thoughts to promote minimization of negative cognitions B. To apply a variety of methods to create change in an individual's thinking C. To apply cognitive principles in order to change an individual's basic schema D. To modify belief systems in an effort to bring about emotional change E. To modify belief systems in an effort to bring about behavioral change

ANS: B, D, E In cognitive therapy, the therapist's objective is to use a variety of methods to create change in a client's thinking and belief system, in an effort to bring about lasting emotional and behavioral change. KEY: Cognitive Level: Analysis | Integrated Processes: Teaching/Learning | Client Need: Psychosocial Integrity

Because of cultural characteristics, in which of the following cultural groups would a nurse's assessment of mood and affect be most challenging? Select all that apply. A. Arab Americans B. Native Americans C. Latino Americans D. Western European Americans E. Asian Americans

ANS: B, E The nurse should expect that both Native Americans and Asian Americans might be difficult to assess for mood and affect. In both cultures, expressing emotions is difficult. Native Americans are encouraged to not communicate private thoughts. Asian Americans may have a reserved public demeanor and may be perceived as shy or uninterested. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

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

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

Which cultural group is correctly matched with the disease process for which this group is most susceptible? A. African Americans are susceptible to lactose intolerance. B. Western European Americans are susceptible to malaria. C. Arab Americans are susceptible to sickle cell disease. D. Jewish Americans are susceptible to thalassemia.

ANS: C A number of genetic diseases are more common in the Arab American population, including sickle cell disease, tuberculosis, malaria, trachoma, typhus, hepatitis, typhoid fever, dysentery, parasitic infestations, thalassemia, and cardiovascular disease. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

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

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

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

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

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

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

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

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

Which response is known to be a physiological manifestation of relaxation? A. Increased levels of norepinephrine B. Pupil dilation C. Reduced metabolic rate D. Increased levels of blood sugar

ANS: C During relaxation, the metabolic rate decreases.

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

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

A nursing student states, "The instructor gave me a failing grade on my research paper. I know it's because the instructor doesn't like me." Which cognitive error does a nurse recognize in this student's statement? A. Dichotomous thinking B. Catastrophic thinking C. Magnification D. Overgeneralization

ANS: C In magnification, negative events are exaggerated. It is irrational to assume that there is a relationship between failing a paper and being personally disliked by the instructor. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A client asks a nurse what is the difference between modified (or passive) progressive relaxation and progressive relaxation. Which is the most appropriate nursing reply? A. "There is an increased focus on deep breathing in the modified version." B. "Only large muscle groups are targeted in the modified version." C. "There is no muscle contraction in the modified version." D. "The modified version is for clients with preexisting cardiovascular disease."

ANS: C In modified (or passive) progressive relaxation, the muscles are not tensed before relaxing them.

A labor and delivery nurse listens to a new mother relate thoughts regarding her healthy, 8-pound baby girl. Which statement by the mother indicates to the nurse the use of the cognitive error, selective abstraction? A. "My baby is refusing to nurse, and I know it's because she hates me." B. "My baby needs to be under the 'bilirubin lights,' but I resent her time away from me." C. "My baby is wonderful, but I'm depressed because I wanted twins." D. "My baby has an elevated bilirubin, and I know it will get worse and she will die."

ANS: C In selective abstraction the individual focuses attention on evidence that is viewed as a failure (not having twins) rather than any successes (a healthy baby) that have occurred. KEY: Cognitive Level: Application | Integrated Processes: Assessment | Client Need: Psychosocial Integrity

A nurse is preparing to establish a therapeutic relationship with a grieving family from China. Which nursing intervention would be considered most appropriate? A. Touch each member lightly, as this enhances the communication process. B. Direct questions to the young males of the family, as they maintain positions of authority. C. Avoid direct eye contact, as it implies rudeness. D. Remain objective and empathetic, as Asians express feelings freely.

ANS: C In the Asian culture, eye contact is often avoided, as it connotes rudeness and lack of respect. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

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

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

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

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

The nurse should recognize that improvement in concentration and attention occurs with which relaxation technique? A. Biofeedback B. Physical exercise C. Meditation D. Mental imagery

ANS: C Meditation has been found to improve concentration and attention.

Northern European Americans value punctuality, hard work, and the acquisition of material possessions and status. A nurse should recognize that these values may contribute to which form of mental disorders? A. Dissociative disorders B. Neurocognitive disorders C. Stress-related disorders D. Schizophrenia spectrum disorders

ANS: C Northern European American values, such as punctuality, hard work, and acquisition of material possessions, may place this group at risk for stress-related disorders when individuals struggle to meet societal demands. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Analysis | Client Need: Psychosocial Integrity

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

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

Which positive physical benefit would relaxation provide for a client who has experienced stress-related asthma? A. Decreased neurotransmitters B. Decreased blood pressure C. Increased oxygen saturation levels D. Decreased alpha brain waves

ANS: C Relaxation results in increased lung capacity and stable respiratory rate leading to increased oxygen saturation levels.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A Latin American woman refuses to participate in an assertiveness training group. Which cultural belief should a nurse identify as most likely to have influenced this client's decision? A. Future orientation causes the client to devalue assertiveness skills. B. Decreased emotional expression makes it difficult to be assertive. C. Assertiveness techniques may not be aligned with the client's definition of the female role. D. Religious prohibitions prevent the client's participation in assertiveness training.

ANS: C The nurse should identify that the Latin American woman's refusal to participate in an assertiveness training group may be influenced by the Latin American cultural definition of the female role. Latin Americans place a high value on the male-dominated family. The father usually possesses the ultimate authority. KEY: Cognitive Level: Application | Integrated Processes: Evaluation | Client Need: Psychosocial Integrity

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

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

A nurse should recognize that clients who have a history of missed or late medical appointments are most likely to come from which cultural group? A. Northern European Americans B. Asian Americans C. Native Americans D. Jewish Americans

ANS: C The nurse should recognize that Native American clients might have a history of missed or late medical appointments. Many Native Americans are not ruled by the clock. The concept of time is casual and focused on the present. KEY: Cognitive Level: Application | Integrated Processes: Assessment | Client Need: Psychosocial Integrity

A client recovering from alcohol toxicity is using minimization. Which statement reflects this cognitive distortion? A. "I can't give up alcohol right now because I just gave up smoking." B. "I just read that red wine has health benefits." C. "I may have a minor problem, but I can handle it." D. "I don't drink as much as my wife, and nobody thinks she has a problem."

ANS: C The statement "I may have a minor problem, but I can handle it" is an example of the use of the cognitive distortion of minimization. Minimization is the undervaluing of the positive significance of an event. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

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

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

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

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

When a client's husband comes home late from work, the wife immediately fears infidelity. The advanced practice nurse therapist encourages the wife to consider other explanations for her husband's tardiness. What technique is the nurse using? A. Examination of the evidence B. Decatastrophizing C. Generating alternatives D. Reattribution

ANS: C Using the technique of generating alternatives will assist the client to recognize a wider range of possible explanations for her husband's behavior. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

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

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

A client diagnosed with borderline personality disorder states, "Get out of here. No one cares about me or my situation!" Which nursing reply is an example of a cognitive intervention? A. "You have an anti-anxiety medication ordered. It may make you feel better." B. "It sounds like you are feeling really frustrated." C. "Can you explain further your thinking about your situation?" D. "No one cares about you?"

ANS: C When a nurse asks for an explanation about a client's thinking, the nurse is using a cognitive approach to assessment. The focus of cognitive interventions is on the modification of distorted cognitions and maladaptive behaviors. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

When using a cognitive approach, a nurse would include which point in teaching a client about panic disorder? A. "You might want to stay in the house when you notice the symptoms beginning." B. "Medications such as lorazepam (Ativan) should be taken when symptoms start." C. "Remind yourself that symptoms of a panic attack are time limited and will end." D. "Keep a journal in order to note feelings surrounding the panic attacks."

ANS: C When a nurse reminds a client that symptoms of a panic attack are time limited and will end, the nurse is using the cognitive approach of presenting rational thinking. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A psychiatric nurse is counseling a client who has thought patterns consisting of rapid responses to a situation without rational analysis. What assessment data will the nurse document on this client? A. "Thought patterns are triggered by specific stressful stimuli." B. "Thought patterns contain the client's fundamental beliefs and assumptions." C. "Thought patterns are flexible and based on personal experience." D. "Thought patterns include a predominance of automatic thoughts."

ANS: D According to Beck, automatic thoughts consist of rapid responses to a situation without rational analysis. These thoughts are often negative and based on erroneous logic. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

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

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

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

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

A welder has been selected as employee of the year. The welder wants to ask for a promotion but is hampered by poor self-esteem. The employee health nurse provides assistance. Which technique should the nurse use to help the employee request the promotion? A. Socratic questioning B. Activity scheduling C. Distraction D. Cognitive rehearsal

ANS: D Cognitive rehearsal allows the employee to uncover potential automatic thoughts in advance of his or her meeting to request a promotion. This allows the employee to develop strategies to modify any dysfunctional thinking. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

An advanced practice nurse recommends that a client participate in cognitive therapy. The client asks, "What's cognitive therapy and how can it help me?" Which is the nurse's most appropriate reply? A. "It is a system of techniques in which you use positive thinking to improve your mood." B. "It is a long-term interpersonal approach that emphasizes the role of early childhood experiences." C. "It is an interpersonal treatment approach that specifically targets magical thinking." D. "It is a type of psychotherapy that focuses treatment on the modification of distorted thinking and maladaptive behaviors."

ANS: D Cognitive therapy is meant to be a time-limited intervention in which the therapist works in collaboration with the client to modify thinking to eliminate cognitive errors that reinforce emotional disturbances. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A client admitted to a Veterans Administration (VA) hospital with a diagnosis of major depressive disorder tells the nurse, "I failed my battalion by giving the wrong order. Fortunately, no one was injured." Which nursing diagnosis should the nurse assign to this client? A. Chronic low self-esteem B. Risk for self-directed violence C. Powerlessness D. Situational low self-esteem

ANS: D Emotional responses are largely dependent on cognitive appraisals of the significance of environmental cues. The nursing diagnosis of situational low self-esteem is used for individuals who have a negative perception of self-worth in response to a current situation. This client's cognitive appraisal of the situation has led to the diagnosis of major depressive disorder and low self-esteem. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Analysis | Client Need: Psychosocial Integrity

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

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

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

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

A client who has been undergoing stress management training asks a nurse how long practicing stress reduction should last. Which is the most appropriate nursing reply? A. "Until this stressor has resolved." B. "Usually it takes several months before stress is eliminated." C. "Whenever you feel better, you can stop." D. "Managing stress is a lifelong function."

ANS: D Management of stress must be considered a lifelong function. Nurses can help individuals recognize the sources of stress in their lives and identify methods of adaptive coping.

During a psychoeducational group on stress management, a client asks about meditation. Which nursing statement is most accurate regarding meditation? A. "It is a procedure whereby various muscle groups are contracted and relaxed, bringing about an overall sense of relaxation." B. "The procedure is one whereby you use your imagination to relax and reduce the tension in your body." C. "The purpose is to become aware of one's bodily processes and to bring them under conscious control." D. "The goal is to gain mastery and control over one's attention, bringing about a special state of consciousness."

ANS: D Meditation creates a special state of consciousness because attention is concentrated on one thought or object.

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

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

Which should a nurse recognize as the reason that physical exercise is an effective relaxation technique? A. Physical exercise stresses and strengthens the cardiovascular system. B. Physical exercise decreases the metabolic rate. C. Physical exercise decreases levels of norepinephrine in the brain. D. Physical exercise provides a natural outlet for releasing muscle tension.

ANS: D Physical exercise is an effective relaxation technique because it provides a natural outlet for releasing muscle tension produced by the body when stressed.

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

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

Which rationale by a nursing instructor best explains why it is challenging to globally classify the Asian American culture? A. Extremes of emotional expression prevent accurate assessment of this culture. B. Suspicion of Western civilization has resulted in minimal cultural research. C. The small size of this subpopulation makes research virtually impossible. D. The Asian American culture includes individuals from many different countries.

ANS: D The Asian American culture includes peoples and descendents from Japan, China, Vietnam, the Philippines, Thailand, Cambodia, Korea, Laos, India, and the Pacific Islands. Within this culture there are vast differences in values, religious practices, languages, and attitudes. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

A 40-year-old client lives with her parents. She has a high school diploma and works at a low-paying job. Her parents give her a weekly allowance to supplement her income. How should the nurse classify their client-parent boundaries? A. As loose B. As rigid C. As flexible D. As enmeshed

ANS: D The client and her parents are overly dependent. The parents control too many aspects of the client's life. Their boundaries are blurred so that it is hard for the client to differentiate her wants and needs from those of her parents. The client-parent boundaries are enmeshed. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A depressed 21-year-old client has lived with his mother ever since the death of his father 3 years ago. After the client received a college acceptance, the mother repeatedly states, "That's wonderful. I'll be fine all alone." How would the nurse interpret the mother's statements? A. The mother is withholding supportive messages. B. The mother is expressing denigrating remarks. C. The mother is communicating indirectly. D. The mother is using double-bind communication.

ANS: D The client's mother says she is fine with him going away to college but then tries to make him feel guilty about her being left alone. The client is in a no-win situation because his mother has given a mixed message—a double-bind communication. KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Analysis | Client Need: Psychosocial Integrity

A client is experiencing auditory hallucinations. Using a cognitive strategy, the nurse would encourage the client to do which of these? A. "Try singing Happy Birthday until the voices are gone." B. "Document what the voices are saying, to note cause and effect." C. "Try listening to music using headphones for distraction." D. "Remind yourself that the voices are symptoms of your disease."

ANS: D The focus of cognitive therapy is on the modification of distorted cognitions and maladaptive behaviors. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

Which group leader activity should a nurse identify as being most important in the final, or termination, phase of group development? A. The group leader establishes the rules that will govern the group after discharge. B. The group leader encourages members to rely on each other for problem solving. C. The group leader presents and discusses the concept of group termination. D. The group leader helps the members to process feelings of loss.

ANS: D The most effective intervention in the final, or termination, phase of group development would be for the group leader to help the members to process feelings of loss. The leader should encourage the members to review the goals and discuss outcomes, reminisce about what has occurred, and encourage members to provide feedback to each other about progress. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

An African American youth, growing up in an impoverished neighborhood, presents in the emergency department with bruises to his face, chest, and arms. He appears to be upset, is speaking in a dialect that is difficult for the nurse to understand, and is standing within 6 inches of the nurse's personal space. What cultural consideration should a nurse identify as playing a role in this youth's behavior? A. African Americans frequently speak in different tongues when they are upset. B. Most African Americans have learned to be aggressive when they have to see a health professional. C. African Americans tend to use dialects and invasion of personal space to intimidate others. D. Some African Americans speak in a dialect that is different from standard English and tend toward smaller personal space than that of the dominant culture.

ANS: D The nurse needs to recognize that a tendency toward smaller personal space and the use of dialects different from Standard English are cultural variables and don't necessarily imply aggressive or disrespectful behavior. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

When planning care for a Latino American client, the nurse should be aware of which cultural influence that may impact access to health care? A. The root doctor may be the first contact made when illness is encountered. B. The "yin" and "yang" practitioner may be the first contact made when illness is encountered. C. The shaman may be the first contact made when illness is encountered. D. The curandero may be the first contact made when illness is encountered.

ANS: D The nurse should understand that some Latino Americans may initially contact a curandero when illness is encountered. The curandero is the folk healer who is believed to have a gift from God for healing the sick. Treatments often include supernatural rituals, prayers, magic, practical advice, and indigenous herbs. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

During the sixth week of a 10-week parenting skills group, a nurse observes as several members get into a heated dispute about spanking. As a group, they decide to create a pros-and-cons poster on the use of physical discipline. At this time, what is the role of the group leader? A. To referee the debate B. To adamantly oppose physical discipline measures C. To redirect the group to a less controversial topic D. To encourage the group to solve the problem collectively

ANS: D The role of the group leader is to encourage the group to solve the problem collectively. A democratic leadership style supports members in their participation and problem-solving. Members are encouraged to cooperatively solve issues that relate to the group. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A single, pregnant teenager in a parenting class discloses her ambivalence toward the pregnancy and the subsequent guilt that these thoughts generate. A mother of three admits to having felt that way herself. Which of Yalom's curative group factors does this illustrate? A. Imparting of information B. Instillation of hope C. Altruism D. Universality

ANS: D The scenario is an example of the curative group factor of universality. Universality occurs when individuals realize that they are not alone in the problems, thoughts, and feelings they are experiencing. This realization reduces anxiety by the support and understanding of others. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

In what way should a nurse expect a school-aged child to gain positive self-esteem, according to Erikson's psychosocial developmental stages? A. Through basic need fulfillment and environmental predictability B. Through exploration and experimentation, resulting in self-confidence in ability to perform C. Through positive reinforcement of creativity and recognition of performance D. Through receiving recognition when learning, competing, and performing successfully

ANS: D The school-aged child develops self-confidence by learning, competing, and performing successfully and receiving recognition from significant others, peers, and acquaintances. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A nursing instructor is teaching students about self-help groups like Alcoholics Anonymous (AA). Which student statement indicates that learning has occurred? A. "There is little research to support AA's effectiveness." B. "Self-help groups used to be the treatment of choice, but their popularity is waning." C. "These groups have no external regulation, so clients need to be cautious." D. "Members themselves run the group, with leadership usually rotating among the members"

ANS: D The student indicates an understanding of self-help groups when stating, "Members themselves run the group, with leadership usually rotating among the members." Nurses may or may not be involved in self-help groups. These groups allow members to talk about feelings and reduce feelings of isolation, while receiving support from others undergoing similar experiences. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Health Promotion and Maintenance

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A nurse is caring for a client who has suffered a stress-related myocardial infarction. Which client statement indicates that the client is ready to learn about the relationship of stress to physical illness? A. "I just need to take my blood pressure medication religiously." B. "The first thing I will do, will be to cut down on my smoking." C. "My father had six heart attacks and survived them all. I plan to do the same." D. "I eat well and exercise. What else do you think could have led to my heart attack?"

ANS: D This response shows that the client is seeking information to improve his health and signals openness to change.

A client states, "I keep having horrible nightmares about the car accident that killed my daughter. I shouldn't have taken her with me to the store." Using a cognitive approach, which nursing reply would be most therapeutic? A. "Are other issues from your past affecting your ability to move on?" B. "Describe your current feelings about your loss." C. "Let's talk about something that will help you move on." D. "Can anyone predict when a car accident will happen?"

ANS: D When the nurse attempts to encourage the client to reframe thoughts, the nurse is using a cognitive approach. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

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

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

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

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

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

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

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

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

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

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

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

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