Mental health exam 1

A patient discloses several concerns and associated feelings. If the nurse wants to seek clarification, which comment would be appropriate? a. "What are the common elements here?" b. "Tell me again about your experiences." c. "Am I correct in understanding that . . ." d. "Tell me everything from the beginning."

"Am I correct in understanding that..."

The nurse has completed teaching a new nursing graduate on how to avoid being judgmental. Which statement by the new nursing graduate should indicate to the nurse that there is a need for further teaching?

"I don't think you need to do that."

Which individual is demonstrating the highest level of resilience? One who A. becomes depressed after the death of a spouse. b. is able to repress stressors. C. takes a temporary job to maintain financial stability after loss of a permanent job. D. lives in a shelter for 2 years after the home is destroyed by fire.

takes a temporary job to maintain financial stability after loss of a permanent job.

Insurance will not pay for continued private hospitalization of a mentally ill patient. The family considers transferring the patient to a public hospital but expresses concern that the patient will not get any treatment if transferred. Select the nurse's most helpful reply. a. "By law, treatment must be provided. Hospitalization without treatment violates patients' rights." b. "All patients in public hospitals have the right to choose both a primary therapist and a primary nurse." c. "You have a justifiable concern because the right to treatment extends only to provision of food, shelter, and safety." d. "Much will depend on other patients, because the right to treatment for a psychotic patient takes precedence over the right to treatment of a patient who is stable."

"By law, treatment must be provided. Hospitalization without treatment violates patients' rights."

A patient says to the nurse, "I dreamed I was stoned. When I woke up, I felt emotionally drained, as though I hadn't rested well." Which response should the nurse use to clarify the patient's comment? a. "It sounds as though you were uncomfortable with the content of your dream." b. "I understand what you're saying. Bad dreams leave me feeling tired, too." c. "So you feel as though you did not get enough quality sleep last night?" d. "Can you give me an example of what you mean by 'stoned'?"

"Can you give me an example of what you mean by 'stoned'?"

A patient tells the nurse, "I will never be happy until I'm as successful as my older sister." The nurse asks the patient to reassess this statement and reframe it. Which reframed statement by the patient is most likely to promote coping?

"I can find contentment in succeeding at my own job level."

During a one-on-one interaction with the nurse, a patient frequently looks nervously at the door. Select the best comment by the nurse regarding this nonverbal communication. a. "I notice you keep looking toward the door." b. "This is our time together. No one is going to interrupt us." c. "It looks as if you are eager to end our discussion for today." d. "If you are uncomfortable in this room, we can move someplace else."

"I notice you keep looking toward the door."

Which remark by a patient indicates passage from orientation to the working phase of a nurse-patient relationship? a. "I don't have any problems." b. "It is so difficult for me to talk about problems." c. "I don't know how it will help to talk to you about my problems." d. "I want to find a way to deal with my anger without becoming violent."

"I want to find a way to deal with my anger without becoming violent."

A voluntarily hospitalized patient tells the nurse, "Get me the forms for discharge. I want to leave now." Select the nurse's best response. a. "I will get the forms for you right now and bring them to your room." b. "Since you signed your consent for treatment, you may leave if you desire." c. "I will get them for you, but let's talk about your decision to leave treatment." d. "I cannot give you those forms without your health care provider's permission."

"I will get them for you, but let's talk about your decision to leave treatment."

A patient says, "Please don't share information about me with the other people." How should the nurse respond? a. "I will not share information with your family or friends without your permission, but I share information about you with other staff." b. "A therapeutic relationship is just between the nurse and the patient. It is up to you to tell others what you want them to know." c. "It depends on what you choose to tell me. I will be glad to disclose at the end of each session what I will report to others." d. "I cannot tell anyone about you. It will be as though I am talking about my own problems, and we can help each other by keeping it between us."

"I will not share information with your family or friends without your permission, but I share information about you with other staff."

A nurse interacts with a newly hospitalized patient. Select the nurse's comment that applies the communication technique of "offering self."

"I'd like to sit with you for a while to help you get comfortable talking to me."

A new couple just delivered a stillborn infant.

"What can I do for you?"

An adult says, "Most of the time I'm happy and feel good about myself. I have learned that what I get out of something is proportional to the effort I put into it." Which number on this mental health continuum should the nurse select? Mental Illness Mental Health 1 2 3 4 5 a. 1 b. 2 c. 3 d. 4 e. 5

5

What is the legal significance of a nurse's action when a patient verbally refuses medication and the nurse gives the medication over the patient's objection? The nurse

can be charged with battery.

A patient diagnosed with schizophrenia believes a local minister stirred evil spirits. The patient threatens to bomb a local church. The psychiatrist notifies the minister. Select the answer with the correct rationale. The psychiatrist

demonstrated the duty to warn and protect.

A nurse is talking with a patient, and 5 minutes remain in the session. The patient has been silent most of the session. Another patient comes to the door of the room, interrupts, and says to the nurse, "I really need to talk to you." The nurse should: a. invite the interrupting patient to join in the session with the current patient. b. say to the interrupting patient, "I am not available to talk with you at the present time." c. end the unproductive session with the current patient and spend time with the interrupting patient. d. tell the interrupting patient, "This session is 5 more minutes; then I will talk with you."

tell the interrupting patient, "This session is 5 more minutes; then I will talk with you."

A patient says to the nurse, "My father has been dead for over 10 years, but talking to you is almost as comforting as the talks he and I had when I was a child." Which term applies to the patient's comment? A. Superego B. Transference C. Reality testing D. Counter-transference

transference

A nurse wants to demonstrate genuineness with a patient diagnosed with schizophrenia. The nurse should: a. restate what the patient says. b. use congruent communication strategies. c. use self-revelation in patient interactions. d. consistently interpret the patient's behaviors.

use congruent communication strategies.

During which phase of the nurse-patient relationship can the nurse anticipate that identified patient issues will be explored and resolved?

working

As a nurse escorts a patient being discharged after treatment for major depression, the patient gives the nurse a necklace with a heart pendant and says, "Thank you for helping mend my broken heart." Which is the nurse's best response? a. "Accepting gifts violates the policies and procedures of the facility." b. "I'm glad you feel so much better now. Thank you for the beautiful necklace." c. "I'm glad I could help you, but I can't accept the gift. My reward is seeing you with a renewed sense of hope." d. "Helping people is what nursing is all about. It's rewarding to me when patients recognize how hard we work."

"I'm glad I could help you, but I can't accept the gift. My reward is seeing you with a renewed sense of hope."

A client with viral hepatitis is discussing with the nurse the need to avoid alcohol and states, "I'm not sure I can avoid alcohol." What is the most appropriate nursing response?

"I'm not sure that I understand. Would you please explain?"

A patient diagnosed with schizophrenia tells the nurse, "The Central Intelligence Agency is monitoring us through the fluorescent lights in this room. The CIA is everywhere, so be careful what you say." Which response by the nurse is most therapeutic?

"It sounds like you're concerned about your privacy."

A person in the community asks, "Why aren't people with mental illness kept in state institutions anymore?" Select the nurse's best response. a. "Less restrictive settings are available now to care for individuals with mental illness." b. "There are fewer persons with mental illness, so less hospital beds are needed." c. "Most people with mental illness are still in psychiatric institutions." d. "Psychiatric institutions violated patients' rights."

"Less restrictive settings are available now to care for individuals with mental illness."

A nurse presents a community education program about mental illness. Which comment by a participant best demonstrates a correct understanding of mental illness from a biological perspective? A. "My friend has had bipolar disorder for years and many problems have resulted. It's not her fault." B. "Disturbed and conflicted family relationships are usually a starting place for mental illness. C. "Mental illness is the result of developmental complications that cause a person not to grow to their full potential." D. "Some people experience life events so traumatic that they cannot be overcome."

"My friend has had bipolar disorder for years and many problems have resulted. It's not her fault."

An advanced practice nurse observes a novice nurse expressing irritability regarding a patient with a long history of alcoholism and suspects the new nurse is experiencing countertransference. Which comment by the new nurse confirms this suspicion? a. "This patient continues to deny problems resulting from drinking." b. "My parents were alcoholics and often neglected our family." c. "The patient cannot identify any goals for improvement." d. "The patient said I have many traits like her mother."

"My parents were alcoholics and often neglected our family."

The spouse of a patient diagnosed with schizophrenia says, "I don't understand how events from childhood have anything to do with this disabling illness." Which response by the nurse will best help the spouse understand the cause of this disorder? A. "Psychological stress is the basis of most mental disorders." B. "This illness results from developmental factors rather than stress." C. "It must be frustrating for you that your spouse is sick so much of the time." D. "Research shows that this condition more likely has a biological basis."

"Research shows that this condition more likely has a biological basis."

A patient newly diagnosed as HIV-positive seeks the nurse's advice on how to reduce the risk of infections. The patient says, "I went to church years ago and I was in my best health then. Maybe I should start going to church again." Which response will the nurse offer?

"Studies show that spiritual practices can enhance immune system function and coping abilities."

A school age child tells the school nurse, "Other kids call me mean names and will not sit with me at lunch. Nobody likes me." Select the nurse's most therapeutic response.

"Tell me more about how you feel."

An aide in a psychiatric hospital says to the nurse, "We don't have time every day to help each patient complete a menu selection. Let's tell dietary to prepare popular choices and send them to our unit." Select the nurse's best response. a. "Thanks for the suggestion, but that idea may not work because so many patients take MAOI (monoamine oxidase inhibitor) antidepressants." b. "Thanks for the idea, but it's important to treat patients as individuals. Giving choices is one way we can respect patients' individuality." c. "Thank you for the suggestion, but the patients' bill of rights requires us to allow patients to select their own diet." d. "Thank you. That is a very good idea. It will make meal preparation easier for the dietary department."

"Thanks for the idea, but it's important to treat patients as individuals. Giving choices is one way we can respect patients' individuality."

A patient says, "I'm still on restriction, but I want to attend some off-unit activities. Would you ask the doctor to change my privileges?" What is the nurse's best response? a. "Why are you asking me when you're able to speak for yourself?" b. "I will be glad to address it when I see your doctor later today." c. "That's a good topic for you to discuss with your doctor." d. "Do you think you can't speak to a doctor?"

"That's a good topic for you to discuss with your doctor."

A nurse explains to the family of a mentally ill patient how a nurse-patient relationship differs from social relationships. Which is the best explanation? a. "The focus is on the patient. Problems are discussed by the nurse and patient, but solutions are implemented by the patient." b. "The focus shifts from nurse to patient as the relationship develops. Advice is given by both, and solutions are implemented." c. "The focus of the relationship is socialization. Mutual needs are met, and feelings are shared openly." d. "The focus is creation of a partnership in which each member is concerned with growth and satisfaction of the other."

"The focus is on the patient. Problems are discussed by the nurse and patient, but solutions are implemented by the patient."

During an interview, a patient attempts to shift the focus from self to the nurse by asking personal questions. The nurse should respond by saying:

"The time we spend together is to discuss your concerns."

The spouse of a terminally ill client steps out of his room in tears. The spouse tells the nurse, "I don't know what I'm going to do when he's gone!" What is the nurse's best response? 1. "This must be very hard for you." 2. "Don't worry, things will be fine." 3. "I know. It will get easier with time." 4. "You need to be strong for him! Don't cry."

"This must be very hard for you."

An adolescent asks a nurse conducting an assessment interview, "Why should I tell you anything? You'll just tell my parents whatever you find out." Which response by the nurse is appropriate? a. "That isn't true. What you tell us is private and held in strict confidence. Your parents have no right to know." b. "Yes, your parents may find out what you say, but it is important that they know about your problems." c. "What you say about feelings is private, but some things, like suicidal thinking, must be reported to the treatment team." d. "It sounds as though you are not really ready to work on your problems and make changes."

"What you say about feelings is private, but some things, like suicidal thinking, must be reported to the treatment team."

A client with a diagnosis of depression who has attempted suicide says to the nurse, "I should have died. I've always been a failure. Nothing ever goes right for me." Which response by the nurse demonstrates therapeutic communication?

"Why do you see yourself as a failure?"

A patient tells the nurse, "I don't think I'll ever get out of here." Select the nurse's most therapeutic response.

"You don't think you're making progress?"

Which statement shows a nurse has empathy for a patient who made a suicide attempt?

"You must have been very upset when you tried to hurt yourself."

A patient with acute depression states, "God is punishing me for my past sins." What is the nurse's most therapeutic response?

"You sound very upset about this."

Which patient is the best candidate for brief psychodynamic therapy? A. An accountant with a loving family and successful career who was involved in a short extramarital affair B. An adult male recently diagnosed with anorexia nervosa C. An adult with a long history of major depression who was charged with driving under the influence D. A woman with a history of borderline personality disorder who recently cut both wrists

An accountant with a loving family and successful career who was involved in a short extramarital affair

Select the example of a tort. a. The plan of care for a patient is not completed within 24 hours of the patient's admission. b. A nurse gives a PRN dose of an antipsychotic drug to an agitated patient because the unit is short-staffed. c. An advanced practice nurse recommends hospitalization for a patient who is dangerous to self and others. d. A patient's admission status changed from involuntary to voluntary after the patient's hallucinations subside.

A nurse gives a prn dose of an antipsychotic drug to an agitated patient because the unit is short-staffed.

A nurse surveys medical records. Which finding signals a violation of patients' rights? a. A patient was not allowed to have visitors. b. A patient's belongings were searched at admission. c. A patient with suicidal ideation was placed on continuous observation. d. Physical restraint was used after a patient was assaultive toward a staff member.

A patient was not allowed to have visitors.

On review of the client's record, the nurse notes that the admission was voluntary. Based on this information, the nurse plans care anticipating which client behavior?

A willingness to participate in the planning of the care and treatment plan.

Which characteristic would be more applicable to a community mental health nurse than to a nurse working in an operating room? A. Autonomy B. Compassion C. Kindness D. professionalism

Autonomy

A community mental health nurse has worked with a patient for 3 years but is moving out of the city and terminates the relationship. When a novice nurse begins work with this patient, what is the starting point for the relationship?

Begin at the orientation phase.

A nurse says, "I am the only one who truly understands this patient. Other staff members are too critical." The nurse's statement indicates: a. boundary blurring. b. sexual harassment. c. positive regard. d. advocacy.

Boundary blurring

A nurse encounters an unfamiliar psychiatric disorder on a new patient's admission form. Which resource should the nurse consult to determine criteria used to establish this diagnosis? a. International Statistical Classification of Diseases and Related Health Problems (ICD-10) b. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) c. A behavioral health reference manual d. The ANA's Psychiatric-Mental Health Nursing Scope and Standards of Practice

Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

A patient says, "People should be allowed to commit suicide without interference from others." A nurse replies, "You're wrong. Nothing is bad enough to justify death." What is the best analysis of this interchange? a. The patient is correct. b. The nurse is correct. c. Neither person is correct. d. Differing values are reflected in the two statements.

Differing values are reflected in the two statements.

At what point in the nurse-patient relationship should a nurse plan to first address termination?

During the orientation phase

Operant conditioning is part of the treatment plan to encourage speech in a child who is nearly mute. Which technique applies? A. Teach the child relaxation techniques. B. Give the child a small treat for speaking. C. Encourage the child to observe others talking. D. Include the child in small group activities.

Give the child a small treat for speaking.

A patient says, "I've done a lot of cheating and manipulating in my relationships." Select a nonjudgmental response by the nurse. a. "How do you feel about that?" b. "I am glad that you realize this." c. "That's not a good way to behave." d. "Have you outgrown that type of behavior?"

How do you feel about that?

A 4-year-old grabs toys from other children and says, "I want that now!" From a psychoanalytic perspective, this behavior is a product of impulses originating in which system of the personality? a. Id b. Ego c. Superego d. Preconscious

ID

The nurse is working with a client who, despite making a heroic effort, was unable to rescue a neighbor trapped in a house fire. Which client-focused action should the nurse engage in during the working phase of the nurse-client relationship?

Inquiring about and examining the client's feelings for any that may block adaptive coping

In a team meeting a nurse says, "I'm concerned about whether we are behaving ethically by using restraint to prevent one patient from self-mutilation, while the care plan for another self-mutilating patient requires one-on-one supervision." Which ethical principle most clearly applies to this situation? a. Beneficence b. Autonomy c. Fidelity d. Justice

Justice

A client with severe psoriasis has a problem of chronic low self-esteem. The nurse should incorporate which nursing action when working with this client?

Listening attentively

A client is participating in a therapy group and focuses on viewing all team members as equally important in helping the clients to meet their goals. The nurse is implementing which therapeutic approach? 1. Milieu therapy 2. Interpersonal therapy 3. Behavior modification 4. Support group therapy

Milieu therapy

A staff nurse completes orientation to a psychiatric unit. This nurse may expect an advanced practice nurse to perform which additional intervention? A. Individualize nursing care plans. B. Conduct mental health assessments. C. Prescribe psychotropic medication. D. Establish therapeutic relationships.

Prescribe psychotropic medication.

As a nurse discharges a patient, the patient gives the nurse a card of appreciation made in an arts and crafts group. What is the nurse's best action? a. Recognize the effectiveness of the relationship and patient's thoughtfulness. Accept the card. b. Inform the patient that accepting gifts violates policies of the facility. Decline the card. c. Acknowledge the patient's transition through the termination phase but decline the card. d. Accept the card and invite the patient to return to participate in other arts and crafts groups.

Recognize the effectiveness of the relationship and patient's thoughtfulness. Accept the card.

Which issues should a nurse address during the first interview with a patient with a psychiatric disorder? a. Trust, congruence, attitudes, and boundaries b. Goals, resistance, unconscious motivations, and diversion c. Relationship parameters, the contract, confidentiality, and termination d. Transference, countertransference, intimacy, and developing resources

Relationship parameters, the contract, confidentiality, and termination

Which technique will best communicate to a patient that the nurse is interested in listening?

Restating a feeling or thought the patient has expressed.

Which principle should guide the nurse in determining the extent of silence to use during patient interview sessions?

Silence can provide meaningful moments for reflection.

The nurse is trying to communicate with a client who had a stroke and has aphasia. Which actions by the nurse would be most helpful to the client? Select all that apply.

Speaking to the client at a slower rate Allowing plenty of time for the client to respond Looking directly at the client during attempts at speech

Which activity is appropriate for a nurse engaged exclusively in community-based primary prevention? A. Substance abuse counseling B. Medication follow-up C. Teaching parenting skills D. Making a referral for family therapy

Teaching parenting skills

During the first interview with a parent whose child died in a car accident, the nurse feels empathic and reaches out to take the patient's hand. Select the correct analysis of the nurse's behavior. a. It shows empathy and compassion. It will encourage the patient to continue to express feelings. b. The gesture is premature. The patient's cultural and individual interpretation of touch is unknown. c. The patient will perceive the gesture as intrusive and overstepping boundaries. d. The action is inappropriate. Psychiatric patients should not be touched.

The gesture is premature. The patient's cultural and individual interpretation of touch is unknown.

The nurse should plan which goals of the termination stage of group development? Select all that apply.

The group evaluates the experience The group explores members' feelings about the group and the impending separation.

After several therapeutic encounters with a patient who recently attempted suicide, which occurrence should cause the nurse to consider the possibility of countertransference? a. The patient's reactions toward the nurse seem realistic and appropriate. b. The patient states, "Talking to you feels like talking to my parents." c. The nurse feels unusually happy when the patient's mood begins to lift. d. The nurse develops a trusting relationship with the patient.

The nurse feels unusually happy when the patient's mood begins to lift.

A Filipino American patient had a nursing diagnosis of situational low self-esteem related to poor social skills as evidenced by lack of eye contact. Interventions were applied to increase the patient's self-esteem but after 3 weeks, the patient's eye contact did not improve. What is the most accurate analysis of this scenario?

The nurse should have assessed the patient's culture before making this diagnosis and plan.

As a patient diagnosed with a mental illness is being discharged from a facility, a nurse invites the patient to the annual staff picnic. What is the best analysis of this scenario? a. The invitation facilitates dependency on the nurse. b. The nurse's action blurs the boundaries of the therapeutic relationship. c. The invitation is therapeutic for the patient's diversional activity deficit. d. The nurse's action assists the patient's integration into community living.

The nurse's action blurs the boundaries of the therapeutic relationship.

When a female Mexican American patient and a female nurse sit together, the patient often holds the nurse's hand. The patient also links arms with the nurse when they walk. The nurse is uncomfortable with this behavior. Which analysis is most accurate? a. The patient is accustomed to touch during conversation, as are members of many Hispanic subcultures. b. The patient understands that touch makes the nurse uncomfortable and controls the relationship based on that factor. c. The patient is afraid of being alone. When touching the nurse, the patient is reassured and comforted. d. The patient is trying to manipulate the nurse using nonverbal techniques.

The patient is accustomed to touch during conversation, as are members of many Hispanic subcultures.

Documentation in a patient's chart shows, "Throughout a 5-minute interaction, patient fidgeted and tapped left foot, periodically covered face with hands, and looked under chair while stating, 'I enjoy spending time with you.'" Which analysis is most accurate? a. The patient is giving positive feedback about the nurse's communication techniques. b. The nurse is viewing the patient's behavior through a cultural filter. c. The patient's verbal and nonverbal messages are incongruent. d. The patient is demonstrating psychotic behaviors.

The patient's verbal and nonverbal messages are incongruent.

A nurse influenced by Peplau's interpersonal theory works with an anxious, withdrawn patient. Interventions should focus on A. administering medications to relieve anxiety. B. rewarding desired behaviors. C. changing the patient's self-concept. D. use of assertive communication.

Use assertive communication

Which documentation of a patient's behavior best demonstrates a nurse's observations? a. Isolates self from others. Frequently fell asleep during group. Vital signs stable. b. Calmer; more cooperative. Participated actively in group. No evidence of psychotic thinking. c. Appeared to hallucinate. Frequently increased volume on television, causing conflict with others. d. Wore four layers of clothing. States, "I need protection from evil bacteria trying to pierce my skin."

Wore four layers of clothing. States, "I need protection from evil bacteria trying to pierce my skin."

Before assessing a new patient, a nurse is told by another health care worker, "I know that patient. No matter how hard we work, there isn't much improvement by the time of discharge." The nurse's responsibility is to A. document the other worker's assessment of the patient. B. assess the patient based on data collected from all sources. C. discuss the worker's impression with the patient during the assessment interview. D. validate the worker's impression by contacting the patient's significant other.

assess the patient based on data collected from all sources.

A Puerto Rican American patient uses dramatic body language when describing emotional discomfort. Which analysis most likely explains the patient's behavior? The patient: a. has a histrionic personality disorder. b. believes dramatic body language is sexually appealing. c. wishes to impress staff with the degree of emotional pain. d. belongs to a culture in which dramatic body language is the norm.

belongs to a culture in which dramatic body language is the norm.

A nurse asks a patient, "If you had fever and vomiting for 3 days, what would you do?" Which aspect of the mental status examination is the nurse assessing? a. Behavior b. Cognition c. Affect and mood d. Perceptual disturbances

cognition

A patient says, "All my life I've been surrounded by stupidity. Everything I buy breaks because the entire American workforce is incompetent." This patient is experiencing a A. deficit in love and belonging. B. cognitive distortion. C. self-esteem deficit. D. deficit in motivation.

cognitive distortion.

At what point in an assessment interview would a nurse ask, "How does your faith help you in stressful situations?" During the assessment of A. educational background B. substance use and abuse C. childhood growth and development D. coping strategies

coping strategies

A nurse assesses a confused older adult. The nurse experiences sadness and reflects, "This patient is like one of my grandparents ... so helpless. Which response is the nurse demonstrating?

countertransference

In the majority culture of the United States, which individual has the greatest risk to be labeled mentally ill? One who A. is wealthy and gives away $20 bills to needy individuals. B. is usually pessimistic but strives to meet personal goals. C. always has an optimistic viewpoint about life and having own needs met. D. describes hearing God's voice speaking.

describes hearing God's voice speaking.

A nurse caring for a withdrawn, suspicious patient recognizes development of feelings of anger toward the patient. The nurse should

discuss the anger with a clinician during a supervisory session.

Which behavior shows that a nurse values autonomy? The nurse: a. suggests one-on-one supervision for a patient who has suicidal thoughts. b. informs a patient that the spouse will not be in during visiting hours. c. discusses options and helps the patient weigh the consequences. d. sets limits on a patient's romantic overtures toward the nurse.

discusses options and helps the patient weigh the consequences.

Termination of a therapeutic nurse-patient relationship has been successful when the nurse: a. avoids upsetting the patient by shifting focus to other patients before the discharge. b. gives the patient a personal telephone number and permission to call after discharge. c. discusses with the patient changes that happened during the relationship and evaluates outcomes. d. offers to meet the patient for coffee and conversation three times a week after discharge.

discusses with the patient changes that happened during the relationship and evaluates outcomes.

A nurse finds a psychiatric advance directive in the medical record of a patient currently experiencing psychosis. The directive was executed during a period when the patient was stable and competent. The nurse should

ensure that the directive is respected in treatment planning.

A patient is having difficulty making a decision. The nurse has mixed feelings about whether to provide advice. Which principle usually applies? Giving advice

is rarely helpful.

The DSM-V classifies: A. people with mental disorders. B. deviant behaviors. C. mental disorders people have. D. present disability or distress.

mental disorders people have.

When a new patient is hospitalized, a nurse takes the patient on a tour, explains rules of the unit, and discusses the daily schedule. The nurse is engaged in A. psychobiological intervention. B. milieu management. C. counseling. D. health teaching.

milieu management.

The patient says, "My marriage is just great. My spouse and I always agree." The nurse observes the patient's foot moving continuously as the patient twirls a shirt button. The conclusion the nurse can draw is that the patient's communication is: a. clear. b. mixed/distorted c. precise. d. inadequate.

mixed/distorted

While talking with a patient diagnosed with major depressive disorder, a nurse notices the patient is unable to maintain eye contact. The patient's chin lowers to the chest. The patient looks at the floor. Which aspect of communication has the nurse assessed?

nonverbal communication

A patient is suspicious and frequently manipulates others. To which psychosexual stage do these traits relate? a. Oral b. Anal c. Phallic d. Genital

oral

Inpatient hospitalization for persons with mental illness is generally reserved for patients who A. are noncompliant with medication at home. B. present a clear danger to self or others. C. have limited support systems in the community. D. develop new symptoms during the course of an illness.

present a clear danger to self or others.

What is the desirable outcome for the orientation stage of a nurse-patient relationship? The patient will demonstrate behaviors that indicate

rapport and trust with the nurse.

A nurse uses Maslow's hierarchy of needs to plan care for a patient diagnosed with mental illness. Which problem will receive priority? The patient A. refuses to eat or bathe. B. is reluctant to participate in unit social activities. C. reports feelings of alienation from family. D. is unaware of medication action and side effects.

refuses to eat or bathe.

Which assessment finding most clearly indicates that a patient may be experiencing a mental illness? The patient A. reports occasional sleeplessness and anxiety. B. is able to describe the difference between "as if" and "for real." C. perceives difficulty making a decision about whether to change jobs. D. reports a consistently sad, discouraged, and hopeless mood.

reports a consistently sad, discouraged, and hopeless mood.

A black patient says to a white nurse, "There's no sense talking about how I feel. You wouldn't understand because you live in a white world." The nurse's best action would be to

say, "Please give an example of something you think I wouldn't understand."

Which finding best indicates that the goal "Demonstrate mentally healthy behavior" was achieved for an adult patient? The patient A. aggressively meets own needs without considering the rights of others. B. behaves without considering the consequences of personal actions. C. seeks help from others when assuming responsibility for major areas of own life. D. sees self as capable of achieving ideals and meeting demands.

sees self as capable of achieving ideals and meeting demands.

A nurse supports a parent for praising a child who behaves in helpful ways to others. When this child behaves with politeness and helpfulness in adulthood, which feeling will most likely result? a. Guilt b. Anxiety c. Humility d. Self-esteem

self-esteem

A nurse introduces the matter of a contract during the first session with a new patient because contracts: a. specify what the nurse will do for the patient. b. spell out the participation and responsibilities of each party. c. indicate the feeling tone established between the participants. d. are binding and prevent either party from prematurely ending the relationship.

spell out the participation and responsibilities of each party.

Which comment best indicates that a patient perceived the nurse was caring? "My nurse: a. always asks me which type of juice I want to help me swallow my medication." b. explained my treatment plan to me and asked for my ideas about how to make it better." c. spends time listening to me talk about my problems. That helps me feel like I am not alone." d. told me that if I take all the medicines the doctor prescribes, then I will get discharged sooner."

spends time listening to me talk about my problems. That helps me feel like I am not alone."

A nurse wants to enhance growth of a patient by showing positive regard. The nurse's action most likely to achieve this goal is: a. making rounds daily. b. staying with a tearful patient. c. administering medication as prescribed. d. examining personal feelings about a patient.

staying with a tearful patient.

A patient states, "I'm not worth anything. I have negative thoughts about myself. I feel anxious and shaky all the time. Sometimes I feel so sad that I want to go to sleep and never wake up." Which nursing intervention should have the highest priority? A. Anxiety self-control measures B. Suicide precautions C. self-esteem-building activities D. Sleep enhancement activities

suicide precautions

A person with a fear of heights drives across a high bridge. Which division of the autonomic nervous system will be stimulated in response to this experience?

sympathetic nervous system