Mental Health exam 1 chapter 1,3,4,5,6,7,8

When planning the discharge of a client with chronic anxiety, which is the most appropriate maintenance goal? 1. Suppressing feelings of anxiety 2. Identifying anxiety-producing situations 3. Continuing contact with a crisis counselor 4. Eliminating all anxiety from daily situations

2. Identifying anxiety-producing situations Recognizing situations that produce anxiety allows the client to prepare to cope with anxiety or avoid a specific stimulus. Counselors will not be available for all anxiety-producing situations, and this option does not encourage the development of internal strengths. Suppressing feelings will not resolve anxiety Elimination of all anxiety from life is impossible. Test-Taking Strategy: Focus on the strategic words, most appropriate. Eliminate any option that contains the closed-ended word "all" or suggests that feelings should be suppressed. Note that the correct option is more client-centered and helps prepare the client to deal with anxiety should it occur.

Which best describes the scope of what community support services provide? Crisis intervention assistance and referral Help with instrumental activities of daily living, such as money management, transportation, and employment opportunities A wide range of services, from health care and education to housing arrangements, employment counseling, and rehabilitation Mental health counseling and medication management

A wide range of services, from health care and education to housing arrangements, employment counseling, and rehabilitation A community support system creates and delivers community-based care to a specific population that traditionally required long-term hospitalization. It includes a range of services: health care, mental health care, rehabilitation, social networks, housing arrangements, and educational and employment opportunities.

Boundaries A client who had been in a substance abuse treatment program asks the nurse for a date after the client is discharged. The nurse talks to the client about the importance of a therapeutic relationship and its characteristics. The nurse is using which of the following techniques? A) Defining boundaries B) Defining therapy C) Letting the client down gently D) Reprimanding the client

A) Defining boundaries A therapeutic relationship is professional, and there are no mutual social goals; it is focused on meeting the client's needs and is terminated when the client no longer needs services. It is up to the nurse to maintain professional boundaries. The other choices would be inappropriate techniques to use toward this client.

The nurse has been working with a patient with an eating disorder for one week. During the morning treatment team meeting, the treatment plan is updated. Which of the following would be appropriate interventions at this time in the nurseñpatient relationship? Select all that apply. A) Exploring perceptions of reality B) Promoting a positive self-concept C) Explaining the boundaries of the relationship D) Working through resistance E) Assisting in identifying problems

A) Exploring perceptions of reality B) Promoting a positive self-concept D) Working through resistance Feedback: Specific tasks of the working phase include maintaining the relationship, gathering more data, exploring perceptions of reality, developing positive coping mechanisms, promoting a positive self-concept, encouraging verbalization of feelings, facilitating behavior change, working through resistance, evaluating progress and redefining goals as appropriate, providing opportunities for the client to practice new behaviors, and promoting independence. Establishing boundaries and identifying problems are completed in the orientation phase.

Phases of the Therapeutic relationship During the orientation phase of the nurse patient relationship, the nurse directs the patient to do which of the following? A) Identify problems to examine B) Express needs and feelings C) Develop interpersonal skills D) Identify self-care strategies

A) Identify problems to examine The orientation phase begins when the nurse and client meet and ends when the client begins to identify problems to examine. Expression of feelings and improving interpersonal skills are tasks of the working phase. Self-care strategies are developed and assessed nearing termination.

The legislation enacted in 1963 was largely responsible for which of the following shifts in care for the mentally ill? A) The widespread use of community-based services B) The advancement in pharmacotherapies C) Increased access to hospitalization D) Improved rights for clients in long-term institutional care

A) The widespread use of community-based services The Community Mental Health Centers Construction Act of 1963 accomplished the release of individuals from long-term stays in state institutions, the decrease in admissions to hospitals, and the development of community-based services as an alternative to hospital care.

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

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

Which is the most restrictive setting in the continuum? Acute inpatient hospitalization Crisis intervention Residential care Partial hospitalization

Acute inpatient hospitalization Of the settings listed, acute inpatient hospitalization involves the most intensive treatment and is considered the most restrictive setting in the continuum. Inpatient treatment is reserved for acutely ill clients who, because of a mental illness, meet one or more of three criteria: (1) high risk for harming themselves, (2) high risk for harming others, or (3) unable to care for their basic needs.

Establishing the therapeutic Relationship A client with depression has been admitted to the mental health unit and is attending group therapy sessions as part of the treatment. The client asks the nurse leading the group if the nurse is married or has a girlfriend. The nurse responds, "I am curious what made you ask this question; however, what is important is how you are feeling today." The nurse's response is what? Appropriate, because the nurse is not in a relationship or married. Inappropriate, because the client was just making small talk about the nurse's personal situation to get to know the nurse better. Inappropriate, because the nurse should have answered to establish a therapeutic relationship. Appropriate, because the focus of the therapeutic relationship is the client, not the nurse.

Appropriate, because the focus of the therapeutic relationship is the client, not the nurse. The nurse's response is appropriate, because the focus of the therapeutic relationship is the client. The other options do not place the focus of care on the client's needs or reflect a full understanding of the therapeutic relationship.

The nurse learns that a new client is a former significant other and an initial session is scheduled for early in the afternoon. Which action should the nurse take to maintain professional boundaries? Plan to meet the client since the personal relationship ended. Ask another nurse to attend the meetings to ensure boundaries are not crossed. Ask to be reassigned because of having a prior personal relationship with the client. Meet for the first session but explain that another nurse will be assigned going forward.

Ask to be reassigned because of having a prior personal relationship with the client. Since the nurse had a previous personal relationship with the client, the therapeutic boundary is questionable. The best course of action would be for the nurse to ask to be reassigned. Meeting the client or asking another nurse to attend could blur the professional-personal boundary. When concerns arise related to therapeutic boundaries, the nurse must seek clinical supervision or transfer the care of the client immediately.

Which role of the nurse is most likely to create difficulty for the nurseñclient relationship if the client confuses physical care with intimacy and sexual interest? A) Teacher B) Caregiver C) Advocate D) Parent surrogate

B) Caregiver Some clients may confuse physical care with intimacy and sexual interest, which can erode the therapeutic relationship. When the nurse is engaged in the role of teacher, the nurse may teach the client new methods of coping and solving problems or he or she may instruct the client about the medication regimen and available community resources. In the advocate role, the nurse informs the client and then supports him or her in whatever decision he or she makes. When a client exhibits child-like behavior or when a nurse is required to provide personal care such as feeding or bathing, the nurse may be tempted to assume the parental role.

The nurse has established a therapeutic relationship with a patient. The patient is beginning to share feelings openly with the nurse. The relationship has entered which phase according to Peplau's theory? A) Orientation B) Identification C) Exploitation D) Resolution

B) Identification The orientation phase is directed by the nurse and involves engaging the client in treatment, providing explanations and information, and answering questions. The identification phase begins when the client works interdependently with the nurse, expresses feelings, and begins to feel stronger. In the exploitation phase, the client makes full use of the services offered. In the resolution phase, the client no longer needs professional services and gives up dependent behavior and the relationship ends.

Which of the following are examples of adventitious crises? Select all that apply. A) Death of a loved one B) Natural disasters C) Violent crimes D) War E) Leaving home for the first time

B) Natural disasters C) Violent crimes D) War Adventitious crises include natural disasters like floods, earthquakes, or hurricanes; war, terrorist attacks; riots; and violent crimes such as rape or murder. Maturational or developmental crises are predictable events in the normal course of life, such as leaving home for the first time, getting married, having a baby, and beginning a career. Situational crises are unanticipated or sudden events that threaten the individual's integrity, such as the death of a loved one, loss of a job, and physical or emotional illness in the individual or family member

13. A client is supposed to be ambulating ad lib. Instead, he refuses to get out of bed, asks for a bed bath, and makes many demands of the nurses. He also yells that they are lazy and incompetent. The client's behavior is an example of which of the following defense mechanisms? A) Introjection B) Projection C) Rationalization D) Reaction formation

B) Projection Projection is blaming unacceptable thoughts on others; the client cannot accept the fact that he may be lazy or incompetent to care for himself. Introjection is accepting another person's attitudes, beliefs, and values as one's own. Rationalization is excusing one's own behavior to avoid guilt, responsibility, conflict, anxiety, or loss of self-concept. Reaction formation is acting the opposite of what one thinks or feels.

What is meant by the term ìrevolving door effectî in mental health care? A) An overall reduction in incidence of severe mental illness B) Shorter and more frequent hospital stays for persons with severe and persistent mental illness C) Flexible treatment settings for mentally ill D) Most effective and least expensive treatment settings

B) Shorter and more frequent hospital stays for persons with severe and persistent mental illness The revolving door effect refers to shorter, but more frequent, hospital stays. Clients are quickly discharged into the community where services are not adequate; without adequate community services, clients become acutely ill and require rehospitalization. The revolving door effect does not refer to flexible treatment settings for mentally ill. Even though hospitalization is more expensive than outpatient treatment, if utilized appropriately could result in stabilization and less need for emergency department visits and/or rehospitalization. The revolving door effect does not relate to the incidence of severe mental illness

Chapter 4 (7) types of treatment setting Which of the following factors is primarily responsible for the changes in inpatient hospital treatment between the 1980s and the present? A) Progress in treatment options for mentally ill persons B) The growth of managed care C) Less stigma associated with mental illness D) The current use of milieu therapy

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

20. Which is included in Healthy People 2020 objectives? A) To decrease the incidence of mental illness B) To increase the number of people who are identified, diagnosed, treated, and helped to live healthier lives C) To provide mental health services only in the community D) To decrease the numbers of people who are being treated for mental illness

B) To increase the number of people who are identified, diagnosed, treated, and helped to live healthier lives One of the Healthy People 2020 objectives is to increase the number of people who are identified, diagnosed, treated, and helped to live healthier lives. It may not be possible to decrease the incidence of mental illness. At this time, the focus is on ensuring that persons with mental illness are receiving needed treatment. It may not be possible or desirable to provide mental health services only in the community.

A college student decides to go to a party the night before a major exam instead of studying. After receiving a low score on the exam, the student tells a fellow student, ìI have to work too much and don't have time to study. It wouldn't matter anyway because the teacher is so unreasonable.î The defense mechanisms the student is using are A) denial and displacement B) rationalization and projection C) reaction formation and resistance D) regression and compensation .

B) rationalization and projection When stating that it wouldn't matter if the student studied, the student is using rationalization, which is excusing own behavior to avoid guilt, responsibility, conflict, anxiety, or loss of self-respect. When stating that the teacher is unreasonable, the student is using projection or the unconscious blaming of unacceptable inclinations or thoughts as an external object. Denial is the failure to acknowledge an unbearable condition. Displacement is the ventilation of intense feelings toward persons less threatening than the one who aroused those feelings. Reaction formation is acting the opposite of what one thinks or feels. Resistance is overt or covert antagonism toward remembering or processing anxiety-producing information. Regression is moving back to a previous developmental stage to feel safe or have needs met. Compensation is overachievement in one area to offset real or perceived deficiencies in another area

Psychiatric nursing became a requirement in nursing education in which year? A) 1930 B) 1940 C) 1950 D) 1960

C) 1950 It was not until 1950 that the National League for Nursing, which accredits nursing programs, required schools to include an experience in psychiatric nursing.

Areas of Practice (Basic and advanced-level function) There are many areas of practice in psychiatric mental health nursing. One of those is advanced-level practice. Which of the following is considered an advanced-level function? A) Case management B) Counseling C) Evaluation D) Health teaching

C) Evaluation Advanced-level functions are psychotherapy, prescriptive authority, consultation and liaison, evaluation, and program development and management. Case management, counseling, and health teaching are basic-level functions in the practice area of psychiatric mental health nursing.

Which of the following are true regarding mental health and mental illness? A) Behavior that may be viewed as acceptable in one culture is always unacceptable in other cultures. B) It is easy to determine if a person is mentally healthy or mentally ill. C) In most cases, mental health is a state of emotional, psychological, and social wellness evidenced by satisfying interpersonal relationships, effective behavior and coping, positive self-concept, and emotional stability. D) Persons who engage in fantasies are mentally ill.

C) In most cases, mental health is a state of emotional, psychological, and social wellness evidenced by satisfying interpersonal relationships, effective behavior and coping, positive self-concept, and emotional stability. What one society may view as acceptable and appropriate behavior, another society may see that as maladaptive, and inappropriate. Mental health and mental illness are difficult to define precisely. In most cases, mental health is a state of emotional, psychological, and social wellness evidenced by satisfying interpersonal relationships, effective behavior and coping, positive self-concept, and emotional stability. Persons who engage in fantasies may be mentally healthy, but the inability to distinguish reality from fantasy is an individual factor that may contribute to mental illness.

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

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

The nurse is assessing a client who is talking about her son's recent death but who shows no emotion of any kind. The nurse recognizes this behavior as which of the following defense mechanisms? A) Dissociation B) Displacement C) Intellectualization D) Suppression

C) Intellectualization The client is aware of the facts of the situation but does not show the emotions associated with the situation. Dissociation involves dealing with emotional conflict by a temporary alteration in consciousness or identity. Displacement is the ventilation of intense feelings toward a person less threatening than the one who aroused those feelings. Suppression is replacing the desired gratification with one that is more readily available.

Psychiatric Nursing Practice The first training of nurses to work with persons with mental illness was in 1882 in which state? A) California B) Illinois C) Massachusetts D) New York

C) Massachusetts The first training for nurses to work with persons with mental illness was in 1882 at McLean Hospital in Belmont, Massachusetts.

Which of the following statements is true of treatment of people with mental illness in the United States today? A) Substance abuse is effectively treated with brief hospitalization. B) Financial resources are reallocated from state hospitals to community programs and support. C) Only 25% of people needing mental health services are receiving those services. D) Emergency department visits by persons who are acutely disturbed are declining.

C) Only 25% of people needing mental health services are receiving those services. Only one in four (25%) adults needing mental health care receives the needed services. Substance abuse issues cannot be dealt with in the 3 to 5 days typical for admissions in the current managed care environment. Money saved by states when state hospitals were closed has not been transferred to community programs and support. Although people with severe and persistent mental illness have shorter hospital stays, they are admitted to hospitals more frequently. In some cities, emergency department visits for acutely disturbed persons have increased by 400% to 500%.

A nurse and patient have just completed reviewing the patient's take-home medications. The nurse is exemplifying which role during this intervention? A) Advocate B) Caregiver C) Teacher D) Parent Surrogate

C) Teacher During the working phase of the nurseñclient relationship, the nurse may teach the client new methods of coping and solving problems. He or she may instruct about the medication regimen and available community resources. The caregiver role is used when the nurse helps the client meet psychosocial or physical needs. When functioning as an advocate, the nurse is acting on the client's behalf when he or she cannot do so. Nurses may need to assume a parental role when the patient needs nurturing or limit setting.

chapter 3 Crisis Intervention The nurse understands that crises are self-limiting. This implies that upon evaluation of crisis intervention, the nurse should assess for which outcome? A) The patient will identify possible causes for the crisis. B) The patient will discover a new sense of self-sufficiency in coping. C) The patient will resume the precrisis level of functioning. D) The patient will express anger regarding the crisis event. F

C) The patient will resume the precrisis level of functioning. Crises usually exist for 4 to 6 weeks. At the end of that time, the crisis is resolved in one of three ways. In the first two, the person either returns to his or her precrisis level of functioning or begins to function at a higher level; both are positive outcomes for the individual. The third resolution is that the person's functioning stabilizes at a level lower than precrisis functioning, which is a negative outcome for the individual. Assisting the person to use existing supports or helping the individual find new sources of support can decrease the feelings of being alone or overwhelmed. The patient may develop guilt if he or she examines possible causes for the crisis. Expression of anger at 4 to 6 weeks indicates a less than favorable outcome of crisis intervention.

Group members are actively discussing a common topic. Members are sharing that they identify with what others are saying. The nurse leader recognizes that the group is in which stage of group development? A) Planning B) Initial C) Working D) Termination

C) Working The working stage of group development begins as members begin to focus their attention on the purpose or task the group is trying to accomplish. The beginning stage of group development, or the initial stage, commences as soon as the group begins to meet. Members introduce themselves, a leader can be selected, the group purpose is discussed, and rules and expectations for group participation are reviewed. The final stage, or termination, of the group occurs before the group disbands. The work of the group is reviewed, with the focus on group accomplishments or growth of group members.

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

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

A student nurse attends a self-help group as part of a class assignment. While there the student recognizes a family friend. Upon returning home, the student talks about the experience with the family. The student's actions can be described as A) appropriate; persons familiar with group members are allowed self-help group membership. B) appropriate; self-help groups are not professional and therefore are open to public knowledge. C) inappropriate; most self-help groups have a rule of confidentiality. D) inappropriate; the student should not have been allowed to attend the group.

C) inappropriate; most self-help groups have a rule of confidentiality. Most self-help groups have a rule of confidentiality: whoever is seen and whatever is said at the meetings cannot be divulged to others or discussed outside the group. In many 12-step programs, such as Alcoholics Anonymous and Gamblers Anonymous, people use only their first names, so their identities are not divulged (although in some settings, group members do know one another's names).

A teenage patient defies the nurse's repeated requests to turn off the video game and go to sleep. The teen says angrily, ìYou sound just like my mother at home!î and continues to play the video game. The nurse understands that this statement likely indicates A) the need of stricter discipline at home. B) early signs of oppositional defiant disorder. C) viewing the nurse as her mother. D) expression of developing autonomy.

C) viewing the nurse as her mother. Transference occurs when the client displaces onto the therapist attitudes and feelings that the client originally experienced in other relationships. Transference patterns are automatic and unconscious in the therapeutic relationship. The occurrence of transference does not indicate ineffective parenting or disciplinary practices, nor is it indicative of a disorder. Autonomy is developed much earlier in the toddler years.

A nurse demonstrates a sound understanding of the use of ego defense mechanisms by providing which explanation? Can be either a therapeutic or a pathological way to manage stress Should be used only when faced with severe stressors Are substitutes for effective coping skills Are often symptomatic of moderate to severe mental illness Can be either a therapeutic or a pathological way to manage stress

Can be either a therapeutic or a pathological way to manage stress Depending upon their use, ego defense mechanisms can be therapeutic or pathologic, because all defense mechanisms include a distortion of reality, some degree of self-deception, and what appears to be irrational behavior. Ego defense mechanisms are considered healthy protective barriers when appropriately used to manage instinct and affect in stressful situations. Ego defense mechanisms when appropriately used are coping skills used to resolve a mental conflict, to reduce anxiety or fear, to protect one's self-esteem, or to protect one's sense of security. deception lua doi

Coordination of care uses services that enable individualized care. Which type of service is also known as the "broker" model? Respite residential care Crisis intervention Case management Partial hospitalization

Case management Coordinated care is often accomplished through a case management service model in which a case manager locates services, links the patient with them, and then monitors the patient's receipt of these services. This type of case management is referred to as the "broker" model. Crisis intervention, partial hospitalization, and respite residential care are not known as the "broker" model.

CHAPTER 5 Values, Belief Attitudes A nurse makes the statement in a treatment team meeting, ìIt's not worth it to try to teach this patient how to make better choices. He has been here many times before and goes back home and does the same thing.î The nurse is sharing which of the following? A) Value B) Awareness C) Belief D) Attitude

D) Attitude Attitudes are general feelings or a frame of reference around which a person organizes knowledge about the world and people. Values are abstract standards that give a person a sense of right and wrong and establish a code of conduct for living. Beliefs are ideas that one holds to be true; for example, ìAll old people are hard of hearing,î and ìIf the sun is shining, it will be a good day.

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

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

Which of the following occurrences is considered a breach of professional boundaries? A) Patient asking a nurse for her phone number B) Refusing a gift from a patient C) Changing the subject in response to a patient complement D) Having a lengthy social conversation with a patient

D) Having a lengthy social conversation with a patient The nurse must maintain professional boundaries to ensure the best therapeutic outcomes. The nurse must act warmly and empathetically but must not try to be friends with the client. Social interactions that continue beyond the first few minutes of a meeting contribute to the conversation staying on the surface. This lack of focus on the problems erodes the professional relationship. The nurse is responsible for maintaining boundaries in the event of patient inappropriateness.

A nursing supervisor reprimands an employee for being chronically late for work. If the employee handles the reprimand using the defense mechanism of displacement, he would most likely do which of the following? A) Argue with the supervisor that he is usually on time B) Make a special effort to be on time tomorrow C) Tell fellow employees that the supervisor is picking on him D) Tell the unit housekeeper that his work is sloppy reprimands khien trach

D) Tell the unit housekeeper that his work is sloppy Displacement involves venting feelings toward another, less threatening person. Arguing is denial. Making a special effort is compensation. Telling fellow employees that the supervisor is picking on him is projection.

DSMV-TR diagnostic and statistical manual of mental disorders, fifth edition, text revision The nurse consults the DSM for which of the following purposes? A) To devise a plan of care for a newly admitted client B) To predict the client's prognosis of treatment outcomes C) To document the appropriate diagnostic code in the client's medical record D) To serve as a guide for client assessment

D) To serve as a guide for client assessment The DSM provides standard nomenclature, presents defining characteristics, and identifies underlying causes of mental disorders. It does not provide care plans or prognostic outcomes of treatment. Diagnosis of mental illness is not within the generalist RN's scope of practice, so documenting the code in the medical record would be inappropriate. nomenclature: danh phap name, designation

Which of the following is the priority of the Healthy People 2020 objectives for mental health? A) Improved inpatient care B) Primary prevention of emotional problems C) Stress reduction and management D) Treatment of mental illness

D) Treatment of mental illness The objectives are to increase the number of people who are identified, diagnosed, treated, and helped to live healthier lives. The objectives also strive to decrease rates of suicide and homelessness, to increase employment among those with serious mental illness, and to provide more services both for juveniles and for adults who are incarcerated and have mental health problems. Answer choices A, B, and C are not priorities of Healthy People 2020.

Self Awareness When preparing for the first clinical experience with patients on a forensic unit at a psychiatric hospital, the nursing instructor discusses students' beliefs and fears surrounding forensic patients. The primary reason for discussing personal beliefs is to A) practice reflective communication skills in a role-play situation. B) assign the most compatible patients to the students. C) assess the appropriateness of the setting for implementing nursing skills. D) become aware of possible barriers to developing therapeutic relationships.

D) become aware of possible barriers to developing therapeutic relationships. Self-awareness allows the nurse to observe, pay attention to, and understand the subtle responses and reactions of clients when interacting with them. Nurses are responsible for caring for patients in all settings and build therapeutic relationship skills regardless of personal beliefs.

During the initial interview with a client in crisis, the initial priority is to A) assess the adequacy of the support system. B) assess for substance use. C) determine the precrisis level of functioning. D) evaluate the potential for self-harm.

D) evaluate the potential for self-harm. Safety is always the priority; clients in crisis may be suicidal. Assessing the adequacy of the support system, assessing for substance use, and determining the precrisis level of functioning would be important assessments but not as high priority as evaluating the potential for self-harm.

A patient has just been told she has cervical cancer. When asked about how this is impacting her, she states, It's just an infection; it will clear up. The statement indicates that this patient A) needs education on cervical cancer. B) is unable to express her true emotions. C) should be immediately referred to a cancer support group. D) is using denial to protect herself from an emotionally painful thought.

D) is using denial to protect herself from an emotionally painful thought. Ego defense mechanisms are methods of attempting to protect the self and cope with basic drives or emotionally painful thoughts, feelings, or events. Most defense mechanisms operate at the unconscious level of awareness, so people are not aware of what they are doing and often need help to see the reality. Education and referrals are premature at this point in the patient's ability to cope.

Which group role is best reflected by the client who consistently validates members' contributions, tries to be the "mediator" between members, and interprets the group's procedures? Group cohesion Group building and maintenance Task Individual

Group building and maintenance Group building and maintenance roles are oriented toward overall group functioning. They alter or maintain the way of working to strengthen, regulate, and perpetuate the group. Individually oriented behavior, which often stems from anxiety, distracts from and temporarily stymies the group and its progress. Task roles promote growth and productivity. Group cohesion relates to bonding and solidarity, the feeling of "we" instead of "I.

When focusing on the primary goal of crisis therapy, a psychiatric nurse counsels a single mother who is recovering from a suicide attempt to help her achieve which goal? Help regain confidence in her pervious ability to cope with the stress of being a single parent Help her identify reliable, affordable help with her childcare needs Comply with her prescribed therapies including the use of an antidepressant Rely more on her extended family's offer to act as a support system

Help regain confidence in her pervious ability to cope with the stress of being a single parent The psychiatric nurse uses counseling interventions to assist clients in improving or regaining their previous coping abilities since the primary goal of crisis therapy is to regain precrisis levels of function. When focusing on the primary goal of crisis therapy, a psychiatric nurse counsels a single mother who is recovering from a suicide attempt to help her regain confidence in her pervious ability to cope with the stress of being a single parent.

Assertive Community Treatment (ACT) reduces the use of which type of service? Detoxification In-patient Hospital Community based Crisis intervention

In-patient Hospital ACT, a community based service, reduces the use of hospital and emergency room services, which in turn reduces the cost of mental health treatment for clients with serious mental illnesses. ACT does not reduce the use of crisis intervention, or detoxification.

Which phase of individual psychotherapy involves establishing mutual boundaries of the relationship between the client and the mental health nurse? Resolution Termination Working Introductory

Introductory During the introductory phase, the therapist and the client establish boundaries of the relationship. Resolution occurs in the working phase. The working phase occurs when the therapist and the client focus on the client's problems and reach an understanding of why the problems have occurred. The termination phase occurs when the client has achieved the maximum benefit of therapy.

A client diagnosed with schizophrenia has recently become divorced and is living in public housing. How would the DSM-5 best help in planning this client's care? It is used by the mental health team to identify the psychosocial and environmental factors currently affecting the client. It is used by all mental health professionals to identify and treat the mentally ill client. It provides the mental health team with links to the latest clinical research on schizophrenia. It provides information on all major mental health disorders and their effect on existing health issues.

It is used by the mental health team to identify the psychosocial and environmental factors currently affecting the client. While all the options are correct, the primary benefit the DSM-5 has for effective care planning for this client is that it assists in identifying psychosocial and environmental factors that may affect the client's treatment and prognosis. None of the other options has this direct connection to the client's specialized needs.

A 35-year-old was discharged from care after recovery from depression. The nurse therapist and the client spent many hours working through issues related to the depression. Six months later, the client is admitted again for depressionassociated with issues similar to those that were previously addressed in the client's therapy. The nurse therapist says to a coworker, "This is unbelievable; we're back at square one again. The client should know better at this point." The nurse's comments reflect what? Poor boundaries A judgmental attitude Exploitation Countertransference

Judgmental attitudes and preconceptions deter the development of therapeutic relationships. Nurses must examine their own beliefs about mental illness, such as believing that mental illness is as real as any physical illness, suspecting that clients are overdramatizing their symptoms or using them as a crutch to avoid work and social responsibility, viewing mental illness as a sign of a weak character, or asking, "Why doesn't this person just snap out of it, put his or her problems in perspective, or focus on something else?"

The nurse is explaining the hospital routines and expectations to a newly admitted client. The nurse also asks if the client has any questions surrounding the admission. Which stage is this according to Peplau's concept of the nurse-patient therapeutic relationship? Resolution Exploitation Orientation Identification

Orientation Explaining the hospital routines and asking if the client has any questions are an attempt to engage the client in the treatment process. During this orientation phase of the therapeutic nurse-patient relationship, the nurse will also clarify the client's problems and needs. In the identification stage, the client works interdependently with the nurse, begins to share feelings with the nurse, and starts feeling stronger. In the exploitation phase, the client makes full use of the services offered by the nurse and other health care personnel. The client starts making goals such as going home and working independently. The resolution phase indicates the end of therapeutic nurse-patient relationship. The client no longer needs professional services and gives up dependent behavior.

Role of the Nurse in the Therapeutic Relationship When the nurse helps the cognitively impaired client bathe and dress, what role is the nurse assuming? Parent surrogate Teacher Advocate Caregiver

Parent surrogate The nurturing needs of clients who are unable to carry out simple tasks are met by the subrole of the parent surrogate. This not the focus of the other roles.

A nurse is conducting a 6-week social skills training program. A young adult with schizophrenia asks the nurse to call the client on the weekends so the client has someone to talk to who really cares. Which action should the nurse take? Tell the client the nurse will call once per week during office hours so that the client can practice phone skills Remind the client about the importance of boundaries to keep the relationship therapeutic Call the client once each weekend to build trust Tell the client to call the office answering service in case of an emergency

Remind the client about the importance of boundaries to keep the relationship therapeutic Explanation: Nurses need to set limits with clients so that the boundaries of the relationship remain intact. Becoming overly involved with clients in inappropriate ways is evidence of a lack of self-awareness (making extra visits when time does not allow for them or calling clients when off duty).

A nurse is caring for a client with posttraumatic stress disorder. Which behavior of the client indicates the resolution phase? The client explores the emotions and feelings related to the traumatic experience. The client becomes more expressive about the client's feelings to the nurse. The client is able to independently express feelings and emotions with the client's friends. The client tries different coping strategies to deal with stress.

The client is able to independently express feelings and emotions with the client's friends. Explanation: During the resolution phase, the client connects with community resources, solidifies a newly found understanding, and practices new behaviors. The client also interacts with significant others in new ways. Trying different coping strategies, exploring emotions and feelings, and increasing ability to express feelings would occur during the working phase.

Avoiding which outcome is the primary reason for establishing professional boundaries with clients? The loss of therapeutic effectiveness The possibility of losing control of the milieu The likelihood of a client becoming too dependent on the nurse The possibility of inappropriate sexual tension developing

The loss of therapeutic effectiveness The priority reason the psychiatric nurse is careful to maintain professional boundaries with clients is to avoid the loss of therapeutic effectiveness. While the other options can result during the course of a relationship, none of them is the priority reason the psychiatric nurse is careful to maintain professional boundaries with clients.

Cost containment & Managed Care Which is the greatest barrier to an individual's ability to obtain the most effective and safest psychiatric medication? These medications are often not covered by the managed care system because they are expensive. These medications are not available because they are in such great demand. These medications are paid for by all insurance companies, but clients do not like to take psychotropics. The side effects of newer medications are often too severe for clients to consider taking them.

These medications are often not covered by the managed care system because they are expensive. Managed care provides for the least costly treatment available. If less costly medicines are effective, they will be the approved treatments. The newer drugs have demonstrated superior effectiveness and safety profiles (i.e., serious and less frequent side effects) and are now available.

A 54-year-old with severe and persistent mental illness and has been referred to a community support system. What is the basic philosophy behind community support systems? To increase the community's acceptance of individuals with mental illness To ensure that clients comply with their medication regimens to prevent relapse To address the needs of adults with mental illness and increase their ability to function To teach the community about mental illness in order to prevent stigma

To address the needs of adults with mental illness and increase their ability to function A community support system is a network of people committed to helping a vulnerable population meet its needs and reach its potentials without unnecessary isolation or exclusion. This basic philosophy of care is meant to address humanely the needs of adults with serious and persistent mental illness, which limits their ability to function in the primary areas of daily living.

A nurse is working with a patient whose background is very different from hers. A good question to ask herself to assure she can be effective working with this patient would be, A) ìCan this person understand me?î B) ìDo I understand this patient's expectations of me?î C) ìWhat experiences do I have with people with similar backgrounds?î D) ìIs this person going to be able to relate to me?î

To best assess self-awareness, the nurse should ask ìWhat experiences have I had with people from ethnic groups, socioeconomic classes, religions, age groups, or communities different from my own?î The nurse should not focus on the patient when examining self-awareness, rather, how the nurse's experiences have shaped attitudes and beliefs.

Which would be a reason for a student nurse to use the DSM? A) Identifying the medical diagnosis B) Treat clients C) Evaluate treatments D) Understand the reason for the admission and the nature of psychiatric illnesses.

Understand the reason for the admission and the nature of psychiatric illnesses. Although student nurses do not use the DSM to diagnose clients, they will find it a helpful resource to understand the reason for the admission and to begin building knowledge about the nature of psychiatric illnesses. Identifying the medical diagnosis, treating, and evaluating treatments are not a part of the nursing process.

A client will soon be completing a course of inpatient treatment for the treatment of schizophrenia. At what point should the care team review the client's eligibility for additional services, coverage, and programs in the community? When requested by the client's health maintenance organization (HMO) When the client and/or client's family advocates for such a review Upon admission to the inpatient setting Once the client experiences an exacerbation of symptoms

Upon admission to the inpatient setting It is important that a client's mental health benefits be reviewed during the discharge planning process, which should always aim to begin at the client's admission to the inpatient unit.

What best describes the use of psychotherapy as a mental health intervention? used for clients with Axis I disorders bringing about a change in feelings, attitudes, thinking, and behavior a type of psychoanalysis a form of behavior therapy that includes behavior modification

bringing about a change in feelings, attitudes, thinking, and behavior Psychotherapy is a process by which a trained person applies principles for establishing a professional relationship sought by people who need help with psychological problems through which learning or human development occurs. Psychotherapy, by definition, is a method of bringing about change in a person by exploring their feelings, attitudes, thinking, and behavior.

The nurse is meeting with a client experiencing a mood disorder. Which client statement indicates that the nurse-client relationship has been established? "I feel worthless and have no real use in life." "I really don't want to talk about that right now." "What difference does it make what I say to you?" "I know you are busy. I don't have much to say now."

"I feel worthless and have no real use in life." People with psychiatric problems often feel alone and isolated. Establishing rapport helps lessen feelings of being alone. When rapport develops, a client feels comfortable with the nurse and finds self-disclosure easier. The nurse also feels comfortable and recognizes that an interpersonal bond or alliance is developing. All of these factors—comfort, sense of sharing, and decreased anxiety—are important in establishing and building the nurse-client relationship. The client stating feelings of worthlessness and having no real use in life demonstrates comfort with the nurse-client relationship. The other statements indicate that the client is not comfortable with the nurse and does not want to share information or take up much of the nurse's time.

During the working phase, a client demonstrates open hostility in reaction to the nurse's last question. Which response should the nurse make to avoid countertransference? "I am only doing my job." "I am only trying to help you." "Tell me why you are angry about what I just said." "If you don't want to continue with me, I'll find someone else."

"Tell me why you are angry about what I just said." Explanation: Countertransference is an emotional reaction to the client based upon personal unconscious needs and conflicts. The nurse should recognize that countertransference can occur and prevent it from eroding the professional boundaries. One way to prevent countertransference is to ask the client to explain why the statement caused hostility. Defending the statement such as saying, "I am only doing my job," "I am only trying to help you," and "I'll find someone else," demonstrates countertransference.

During the next meeting during the working phase of the relationship the client brings the nurse homemade chocolate chip cookies and a box of chocolates. Which response should the nurse make to the client about these gifts? "Thank you but I will not accept these gifts because they extend over our discussed boundaries." "They look delicious and I love candy but I'm on a diet and really can't accept them." "How did you know that I'm a chocoholic? Will you have a cookie with me while we talk?" "Thank you so much. I will share them with the other nurses."

"Thank you but I will not accept these gifts because they extend over our discussed boundaries." During the orientation phase, professional boundaries are set. If the client violates these boundaries, the nurse needs to acknowledge the behavior and reestablish or reinforce the boundaries by not accepting the gifts. Accepting the gifts to share with other nurses or the client violates the professional boundary. Declining the gifts for anything besides the violation of the professional relationship is not honest and may deteriorate the trusting relationship.

The introduction of psychotropic medications occurred in which decade? 1940s 1970s 1950s 1960s

1950s The introduction of psychotropic medication occurred in the 1950s.

Which of the following is most essential when planning care for a client who is experiencing a crisis? A) Explore previous coping strategies B) Explore underlying personality dynamics C) Focus on emotional deficits D) Offer a referral to a self-help group

A) Explore previous coping strategies Crisis intervention focuses on using the person's strengths, such as previous coping skills, and providing support to deal with the current situation. Exploring underlying personality dynamics and focusing on emotional deficits would not help the client in the crisis situation. When the client is in a crisis situation, offering a self-help group would not be appropriate.

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

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

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

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

A client with a diagnosis of bipolar I disorder has been presented with a coping strategy by the therapist that may help the client manage behavior during manic episodes. The client has responded to the therapist's suggestion by saying, "What's the use? I don't ever see this changing." The client's statement is suggestive of a potential problem with what factor that influences communication? Ability to relate to others Knowledge Values Attitude

Attitude A tone of defeatism or resignation is indicative of an attitude that may inhibit communication and treatment.

Community Based Care Which is a positive aspect of treating clients with mental illness in a community-based care? A) You will not be allowed to go out with your friends while in the program. B) You will have to have supervision when you want to go anywhere else in the community. C) You will be able to live in your own home while you still see a therapist regularly. D) You will have someone in your home at all times to ask questions if you have any concerns.

C) You will be able to live in your own home while you still see a therapist regularly. Clients can remain in their communities, maintain contact with family and friends, and enjoy personal freedom that is not possible in an institution. Full-time home care is not included in community-based programs.

An adolescent patient has just been found to have broken one of the unit rules. The nurse imposes the consequence of losing phone privileges. In this instance, the nurse is acting as A) advocate. B) caregiver. C) teacher. D) parent surrogate.

D) parent surrogate. During the working phase of the nurse and client relationship, nurses may need to assume a parental role when the patient needs nurturing or limit-setting. The nurse may also function as a teacher when the client needs to learn new skills, such as methods of coping and solving problems. The caregiver role is used when the nurse helps the client meet psychosocial or physical needs. When functioning as an advocate, the nurse is acting on the client's behalf when he or she cannot do so.

The nurse is reviewing a client's history, which reveals that the client is participating in a psychiatric rehabilitation program. The nurse understands that which is the goal of this program? Carefully detox from alcohol and substance abuse Promote the ability of clients with serious mental illness to live within the community Provide self-help groups and training in daily living Empower clients to achieve the highest level of functioning possible

Empower clients to achieve the highest level of functioning possible Psychiatric rehabilitation programs, also termed psychosocial rehabilitation, focus on the reintegration of people with psychiatric disabilities into the community through work, education, and social avenues while addressing their medical and residential needs. The goal is to empower clients to achieve the highest level of functioning possible. In-home detoxification promotes careful detoxification from alcohol and substances. The Assertive Community Treatment (ACT) model helps individuals with serious mental illness live in the community. Recovery centers assist in the mental health consumer's journey toward recovery by offering self-help groups and training in daily living. In addition, recovery centers offer illness self-management interventions.

The family members of a patient with bipolar disorder express frustration with the unpredictable behaviors of their loved one. Which group should the nurse suggest as most helpful to this family? A) Family therapy group B) Family education group C) Psychotherapy group D) Self-help support group

Family education discusses the clinical treatment of mental illnesses and teaches the knowledge and skills that family members need to cope more effectively. The goals of family therapy groups include understanding how family dynamics contribute to the client's psychopathology, mobilizing the family's inherent strengths and functional resources, restructuring maladaptive family behavioral styles, and strengthening family problem-solving behaviors. The goal of a psychotherapy group is for members to learn about their behavior and to make positive changes in their behavior by interacting and communicating with others. In a self-help group, members share a common experience, but the group is not a formal or structured therapy group

The mental health nurse is responsible for maintaining professional boundaries. Which would be an example of a professional boundary violation? Giving personalized gifts to a client Providing a friendly environment Exhibiting confidentiality Avoiding personal attachment to the client

Giving personalized gifts to a client An example of a professional boundary violation includes giving personal gifts to a client. Providing a friendly environment, exhibiting confidentiality, and avoiding personal attachment to the client are not boundary violations.

Chapter 1 Mental Health VS Mental Illness

MENTAL HEALTH : - a state of emotional, psychological, and social wellness evidenced by satisfying interpersonal relationships, effective behavior and coping, positive self-concept, and emotional stability. "Mental health is marked by productivity, fulfilling relationships, and adaptability." Satisfaction with personal relationships and self MENTAL ILLNESS: - Includes disorders that affect mood, behavior, and thinking, such as depression, schizophrenia, anxiety disorders, and addictive disorders. - Inability to function in a manner that manages both external and internal stressors effectively

Which intervention is appropriate for a psychiatric-mental health nurse at the basic level of practice? Promoting symptom management Conducting family therapy Prescribing psychotropic medications Interpreting laboratory tests

Promoting symptom management Basic psychiatric-mental health nurses promote and encourage the maintenance of health and prevention of disorders, assess biopsychosocial functioning, serve as case managers, design therapeutic environments, and promote self-care activities, including medication and symptom management. At the advanced level, psychiatric-mental health nurses deliver comprehensive primary mental health services. Functions include delivering psychotherapy, prescribing medications (in many states), teaching and screening, performing preventive interventions, and evaluating and managing care for people with mental illness.

During the termination phase, a client begins to raise old problems that have already been resolved. Which would be appropriate nursing responses? Select all that apply. Immediately stop the client and inform the client that the nurse is running the session. Get angry at the client and ask the client to leave the session. Reassure the client that they already covered these issues. Review with the client the learned methods to control the problems. Do not acknowledge this issue and continue on with the session as planned.

Reassure the client that they already covered these issues. Review with the client the learned methods to control the problems. Explanation: A typical termination behavior is raising old problems that have already been resolved. The nurse may feel frustrated if clients in the termination phase present resolved problems as if they were new. The clients are attempting to prolong the relationship and avoid its ending. Nurses should avoid addressing these problems. Instead, they should reassure clients that they already covered those issues and learned methods to control them.

Which type of care provides periodic relief to caregivers of a mentally ill client? Acute inpatient care Respite residential care Crisis stabilization Partial hospitalization

Respite residential care Sometimes family members of a person with mental illness who lives at home may be unable to provide care continuously. In such cases, respite residential care can provide short-term, necessary housing for the client and provide periodic relief for the caregivers.

A client is referred to a psychosocial rehabilitation program. When explaining this type of care to the client, what would the nurse emphasize? Intensive treatment that prepares the client to live in the community Detoxification services for alcohol and drugs in an outpatient setting Services that promote the client's reintegration into the community Frequent monitoring within a therapeutic milieu for relapse prevention

Services that promote the client's reintegration into the community Psychosocial rehabilitation or psychiatric rehabilitation programs focus on integrating people with psychiatric disabilities into the community through work, education, and social avenues while also addressing their medical and residential needs. The goal is to empower clients to achieve the highest level of functioning possible. Intensive treatment that prepares the client to live in the community reflects the focus of assertive community treatment. Outpatient detoxification provides detoxification services for alcohol and drugs in an outpatient setting. Intensive outpatient programs provide frequent monitoring and social support within a therapeutic milieu to enable the client to remain connected to the community.

A student nurse does not want to think about the upcoming final exam. The student nurse will start studying for the exam tomorrow. The student nurse is exhibiting which type of defense mechanism? Regression Denial Conversion Suppression

Suppression Suppression is the voluntary rejection of unacceptable thoughts or feelings from conscious awareness. Denial is unconscious refusal to face thoughts, feelings, wishes, needs, or reality factors that are intolerable. Regression is the retreat to past developmental states to meet basic needs. Conversion is the unconscious expression of a mental conflict as a physical symptom to relieve tension or anxiety.

For a client who has anxiety, the individual psychotherapy process moves into the working phase when which occurs? The psychiatric assessment process has produced client-focused interventions The client expresses a willingness to discuss what the client thinks is the cause of the anxiety The nurse-client relationship is well established The nurse feels that the client has developed sufficient coping skills to now deal with the stress

The client expresses a willingness to discuss what the client thinks is the cause of the anxiety The anxious client's individual psychotherapy process moves into the working phase when the client expresses a willingness to discuss what the client thinks is the cause of the anxiety, not when the nurse-client relationship is well established, when the nurse feels the client has developed sufficient coping skills to now deal with the stress, or when the psychiatric assessment process has produced client-focused interventions.

Which situation would most likely indicate a violation of professional boundaries? Select all that apply. The nurse refuses a gift from a client and the client's family. The nurse strongly defends a client's behavior during a staff meeting. A nurse tells other staff that the nurse is the only one who understands the client. A nurse begins to spend increasing amounts of time with one client on the unit. A nurse reports information to the physician after the client asks that it be kept a secret.

The nurse strongly defends a client's behavior during a staff meeting. A nurse tells other staff that the nurse is the only one who understands the client. A nurse begins to spend increasing amounts of time with one client on the unit. Indicators that the relationship may be moving outside the professional boundaries are gift giving on either party's part, spending more time than usual with a particular client, strenuously defending or explaining the client's behavior in team meetings, the nurse feeling that he or she is the only one who truly understands the client, keeping secrets, or frequently thinking about the client outside of work. Refusing a gift and reporting information to avoid "secrets" would be appropriate professional behavior that does not violate professional boundaries.

Two staff nurses in a psychiatric emergency department are being considered for a promotion that will be announced via memo on a unit bulletin board. They work in a collaborative team environment, have been colleagues for 15 years, and socialize outside work. Nurse A hears from a third colleague that Nurse B was promoted. Nurse A responds, "I knew I'd never get the job. The nurse manager hates me." Nurse A is most likely demonstrating: reaction formation. compensation. projection. denial.

Unconsciously adopting blaming behavior is called projection, and it allows people to attribute unacceptable feelings to other people. A nurse who is unconsciously attempting to emphasize a strong point in an attempt to make up for a perceived weakness is engaging in compensation. Unconsciously adopting behavior that is the opposite of actual feelings is called reaction formation. Unconsciously ignoring the existence of an unpleasant reality is called denial.

During which phase of the nurse-client relationship does the client identify and explore specific problems? Working Debriefing Orientation Resolution

Working During the working phase, the client uses the relationship to examine specific problems and learn new ways of approaching them. Debriefing is not a phase of the nurse-client relationship. During the orientation phase, the nurse and client get to know each other. The final phase, resolution, is the termination stage of the relationship and lasts from the time the problems are resolved to the close of the relationship.

A group is trying to handle issues related to dominance, control, and power within the group. In what stage of group development is this group? Initial Working Termination Mature

Working During the working stage of group development, the group solves selected problems of working together; handles conflicts between members or between members and the leader; and works on issues of dominance, control, and power within the group.

A nurse is caring for a client with hemiplegia who has been depressed. The client tells the nurse, "I don't feel I would ever be independent again. I would be a burden to everybody in my house." The nurse responds by stating, "Your family misses you a lot and wants you home as soon as possible. The rehab team is very confident about your progress." Which phase of nurse-client relationship is occurring? Orientation Working Resolution Mutual withdrawal

Working The nurse is helping the client to examine the feelings and responses and tries to develop better coping skills and a more positive self-image. The conversation indicates that the client is upset about the client's disability and the nurse is trying to motivate the client. Thus, this conversation is indicative of the working phase. In the orientation phase, the nurse explains the purpose of their meeting and the schedules of the treatment sessions, identifies themes surrounding the client's problems, and clarifies expectations. In the resolution phase, the problems of the client are resolved and the nurse-client relationship comes to an end. Mutual withdrawal is a phase in a nontherapeutic relationship in which the client and nurse give up on each other due to extreme frustration.

The nurse and client are entering the orientation phase of a relationship. Which is the goal for the client during this phase? work through problems resolve pressing problems identify potential solutions to issues develop a sense of trust in the nurse

develop a sense of trust in the nurse Explanation: The orientation phase is the phase during which the nurse and client get to know each other. During this phase, the client develops a sense of trust in the nurse. In the working phase, the client works through problems and identifies potential solutions to issues. During the termination phase, problems are resolved.

Termination takes place during the resolution phase of a nurse-client relationship. During the termination process, a client brings up resolved problems and presents them as new issues to work toward. The nurse interprets the client's action as indicating what? The client: is angry that the nurse is abandoning the client. requires additional therapy. is unhappy that the therapy was ineffective. is attempting to prolong the nurse-client relationship.

is attempting to prolong the nurse-client relationship. Explanation: It is not unusual for clients with mental disorders to bring up resolved problems and present them as new issues during the resolution phase. The client is most likely attempting to prolong the nurse-client relationship. The client may be experiencing anxiety about the relationship ending. Anger typically would be demonstrated toward the nurse or displaced onto others rather than through the use of bringing up resolved problems. The client's actions do not indicate that additional therapy is needed nor that the therapy was ineffective.

The nurse provides care to a client who requires crisis stabilization in a short-term inpatient setting. Which is the priority focus of care for this client? psychoeducation symptom management group psychotherapy seclusion

symptom management When the immediate crisis does not resolve quickly, crisis stabilization is the next step. This type of care usually lasts fewer than 7 days and has a symptom-based indication for hospital admission. The primary purpose of stabilization is control of precipitating symptoms through medications, behavioral interventions, and coordination with other agencies for appropriate aftercare. The major focus of nursing care in a short-term inpatient setting is symptom management. Seclusion and the use of restraints should never be the focus of care; however, these interventions may be required for aggressive or violent clients. Psychoeducation and group psychotherapy may be included with crisis stabilization; however, these are not the priority focus of care