Mental Test Chapter 4-6

When a 23-year-old client is admitted to the psychiatric unit after a suicide attempt, the client states the client is willing to speak to the nurse but only if the conversation remains confidential. Which is the nurse's best response? "Will this conversation involve your desire to harm yourself?" "You know that I can't keep secrets from your health care team." "Without your permission I can't give any information to anyone." "Don't you trust me to respect your right to confidentiality?"

"Will this conversation involve your desire to harm yourself?"

A nurse encourages a client to enroll in outpatient services immediately upon discharge from the inpatient setting. The nurse does this to promote which outcome? Relapse prevention . Community reintegration . Empowerment. Stabilization.

. Community reintegration

How does the rate of suicide among active and veteran military personnel compare to that of the civilian population? 2% lower 2 times higher 3 times lower Equal

2 times higher

The therapeutic communication interaction is most comfortable when the nurse and the client are how far apart? 0 to 18 inches 18 to 36 inches 3 to 6 feet 12 to 25 feet

3 to 6 feet

The population that is mentally ill is arrested and prosecuted at a rate that is how many times that of the general population? 2 3 4 5

4

The nurse is using a directive role when asking a client which question? "Are you thinking about hurting someone else right now?" "Can you tell me more about your relationship with your mother" "How do you feel about being in the hospital?" "How do you feel about being discharged?"

"Are you thinking about hurting someone else right now?"

When a client states, "I will solve my own problems without asking my family for help," which response by the nurse demonstrates a therapeutic use of self? "Asking for help from those who care about us isn't a sign of weakness." "Being self-sufficient is a sign of mental health stability." "Your family would want to help if you had a problem." "How do you plan to manage your problems without help?"

"Asking for help from those who care about us isn't a sign of weakness."

The nurse is assessing a client who was recently diagnosed with anxiety disorder. Which question asked by the nurse conveys a concrete message? "If you just learn how to breathe, you can manage better." "When did you last take drugs?" "How can you make your anxiety better?" "At what time did you take the last dose of the antianxiety drugs?"

"At what time did you take the last dose of the antianxiety drugs?"

A client treated for depression is ready for discharge from the hospital and tells the nurse, "It would be great if we could meet for coffee should I start feeling low again." Which statement indicates that the nurse understands the boundaries of the therapeutic relationship? "That would be fine as long as we go to a public place. Where would you like to meet?" "Before you leave the hospital, I will make sure you have information about the crisis center." "We could go to the gym together. Exercise can be very therapeutic for clients with depression." "I often meet people after they are discharged. Sometimes it is difficult to deal with situations after you leave the hospital."

"Before you leave the hospital, I will make sure you have information about the crisis center."

Which statement by the nurse demonstrates an understanding of the first step in helping a client learn the problem solving process? "What could you do when you are angry that doesn't involve throwing things?" "Can you explain to me what made you so angry?" "What are you going to do the next time you get angry?" "What do you think is the best thing to do when you are angry?"

"Can you explain to me what made you so angry?"

The nurse is asking a client for feedback on the services provided in the hospital. The client responds, "Yeah. It was great." The client spoke in a disgusted and hurried tone and did not make eye contact with the nurse. What is the message conveyed here? "Your services were not good at all." "Don't waste my time asking about your services." "Your services were wonderful. Keep up the good work." "Your services were good, but you could provide much better service."

"Don't waste my time asking about your services."

The nurse is caring for a 42-year-old Asian-American client. Which question would assist the nurse in evaluating the client's cultural needs? "Who or what is your greatest source of comfort?" "What do you do when you need to relax?" "What kinds of activities do you do in your spare time?" "How do you typically respond when people touch you?"

"How do you typically respond when people touch you?"

The nurse is teaching effective anger management. The nurse emphasizes the use of assertive sentences while expressing anger. Which are examples of assertive communication? Select all that apply. "You are making me very angry." "Why are you not listening to me?" "I am frustrated with the situation." "How can you behave like this with me?" "I am feeling disrespected by your comments."

"I am frustrated with the situation." "I am feeling disrespected by your comments."

The nurse is caring for a client with schizophrenia. The client tells the nurse, "My dead mother is calling me, I will finally be with her tonight. Please do not tell anyone." What is the most appropriate nursing response? "Don't worry; I will keep this secret to myself." "Who has influenced you with these ideas?" "I will speak with the health care provider about the possible use of physical restraints for you tonight." "I cannot keep this a secret. I will ensure that the staff helps keep you safe."

"I cannot keep this a secret. I will ensure that the staff helps keep you safe."

A psychiatric-mental health client tells the nurse, "The doctor hates me. The doctor promised to try to come and check on me after dinner yesterday but never came." What is the nurse's most therapeutic response? "I don't know why the doctor didn't come, but I can reassure you that it's not because she hates you." "Since the doctor didn't come yesterday, would you like me to page the doctor to come see you right now?" "Unfortunately, the doctor has an extremely busy schedule and the doctor doesn't always keep up the promises." "I'm sure that the doctor will come and see you as soon as the doctor is free and able to come see you."

"I don't know why the doctor didn't come, but I can reassure you that it's not because she hates you."

A nurse is assessing an elderly client with a cardiac disorder. Which statement given by the client conveys an abstract message? Choose the best answer. "I don't really know how it all started. It just happened." "The chest pain is severe enough to disable me from doing my work." "I suddenly had dull pain around the jaw and neck region." "The sudden onset of my chest pain got my spouse extremely stressed out."

"I don't really know how it all started. It just happened."

A nurse is engaging in an interpersonal interaction with a young adult client who is admitted to the hospital with suicidal ideation. The client states, "I am really not good at anything." How should the nurse respond to the client's statement? "I have a really difficult time believing that." "Everyone is good at something." "You just need to keep a positive attitude." "Did you go to relaxation group today?"

"I have a really difficult time believing that."

A client who is experiencing depression states, "I can't seem to do anything to take care of myself, how can I get going?" What is the nurse's best response? "I notice it has been a while since you have had a shower." "I think you need to take a shower." "Don't worry, take as long as you need before you get going." "Why haven't you taken a shower yet?"

"I notice it has been a while since you have had a shower."

Which statement by the nurse is an example of assertive communication? "You are so rude; I just won't tolerate that in my group." "I'm so happy that you finally decided to join us here in group." "Oh, you must be really busy to be this late getting to group." "I understand that group can be difficult to attend but coming late is disruptive."

"I understand that group can be difficult to attend but coming late is disruptive."

A psychiatric-mental health nurse has been off of work for the past 4 days, as per the normal work schedule on the unit. On the nurse's first day back, a longterm client says, "I haven't seen you around here since Thursday. How was your time off?" What is the nurse's most appropriate response? "I've been off for the past four days. What have you done since I last saw you?" "I'm not at liberty to talk about my personal life outside of work, unfortunately. How have you been?" "How do you like to spend your time when you're able to do whatever you like?" "If you had to guess, what do you think I might have done on my days off?"

"I've been off for the past four days. What have you done since I last saw you?"

The nurse has entered a client's room and observed that the client has removed the mattress from the bed and is closely scrutinizing the spaces in the bed frame. Which statement is most likely to elicit an explanation of the client's behavior? "What's wrong with your bed?" "It looks like you're searching for something. Is that right?" "What are you looking for in the bed? There's nothing hidden there." "Are you having any delusions or hallucinations right now?"

"It looks like you're searching for something. Is that right?"

A female psychiatric client is talking to the nurse about her reasons for being hospitalized. The client begins to discuss her relationship with her female significant other. She is describing the things in her relationship that are making her uncomfortable, and she asks the nurse, "Should I break up with my partner?" Which response by the nurse would be most effective in building rapport between the client and nurse? "Of course you should; being a lesbian is just not natural." "Yes, I think you should pursue building a relationship with a man." "It sounds like you're beginning to be uncomfortable in this relationship." "You need to focus on yourself rather than the relationship right now."

"It sounds like you're beginning to be uncomfortable in this relationship."

A client says, "Nobody listens to me; even you don't!" Which response is most therapeutic? "Why do you say I don't listen to you?" "It sounds like you're overreacting somewhat." "It sounds like you're feeling unappreciated." "I listen to you."

"It sounds like you're feeling unappreciated."

A client on the psychiatric mental health unit has a care plan that includes a break for cigarettes every hour during the afternoon if the client follows the behavioral plan to attend the morning group on anger management. The client asks, "I couldn't get to my group this morning because I overslept. Can I just this one time go for a cigarette now?" Which response by the nurse is most therapeutic? "No, Joe. Your plan says that you need to attend that group in order to have cigarette breaks." "Well, I know you were tired from last night. You can go at 2 p.m." "Why do you think you should be allowed to go for a break?" "Joe, let's review your care plan and discuss whether or not it needs to be revised."

"No, Joe. Your plan says that you need to attend that group in order to have cigarette breaks."

Which statement by the nurse demonstrates acceptance to the client who has made a sexually inappropriate comment? "That type of talk is inappropriate and won't be tolerated." "Why do you think making that comment is appropriate?" "How would you feel if someone said that to you?" "Our relationship is one of a professional nature."

"Our relationship is one of a professional nature."

When a novice psychiatric nurse shares with the nurse manager that talking about sexual abuse with clients is very uncomfortable, which would be the most effective response from the nurse manager? "What specifically makes you uncomfortable?" "I can take that client off of your assignment this shift." "It would be great if you could attend an in-service on therapeutic communication." "Have you ever been sexually abused?"

"What specifically makes you uncomfortable?"

The client presents with signs and symptoms of anxiety. What conversation initiated by the nurse demonstrates an ineffective therapeutic use of self? "How did the pain start?" "What types of dresses do you like wearing?" "Do you take a vegetarian or nonvegetarian diet?" "Do you want me to inform your spouse about your illness?"

"What types of dresses do you like wearing?"

A nurse is seeing a client who has recently been discharged from the hospital for a suicide attempt. When asked about the quality of her relationship with her husband, the client becomes silent, diverts eye contact and says, "It's okay." What is the nurse's best response? "I am glad to hear that." "A good relationship is a sign of recovery." "I don't think you are telling me the truth." "What you are saying and how you say it does not seem to match."

"What you are saying and how you say it does not seem to match."

Which client would be most likely to qualify for psychiatric care in a long-term care setting? A client who has a diagnosis of bipolar disorder and is an intravenous heroin user A client with a recent history of suicide attempts who is scheduled to begin electroshock therapy A client who has multiple sclerosis and a history of depression A client who has schizophrenia and who is estranged from the client's family

A client who has multiple sclerosis and a history of depression

Which client may be the most appropriate candidate for telepsychiatry? A client with bipolar disorder who has been admitted to the hospital during a manic episode A client whose depression does not warrant inpatient or outpatient care but who is motivated to maintain the client's health A client who has been brought to the emergency department because of acute psychosis An inpatient who is on visual checks every 15 minutes as a suicide precaution

A client whose depression does not warrant inpatient or outpatient care but who is motivated to maintain the client's health

Which community activity is an example of tertiary prevention in a community that experienced a massive fire? Mental health professionals offered educational programs on effective coping strategies. A master plan was formulated for what to do in case of another fire. City officials installed warning signals in remote areas where no warning signals were heard. Hospital personnel reviewed their emergency response plans and made changes.

A master plan was formulated for what to do in case of another fire.

Which best defines a community support system in relation to mental illness? An organized system of group housing arrangements designed to support the deinstitutionalization of the mentally ill A network that helps to meet the needs of people with mental illness and to realize their potential without unnecessary isolation A network of 12-step programs and support groups A system of interventions designed to affect macrosystem variables that discriminate against people with mental illness

A network that helps to meet the needs of people with mental illness and to realize their potential without unnecessary isolation

A nurse administrator is observing the behavior of nurses in the hospital. Which behaviors would the nurse administrator consider inappropriate? Select all that apply. A nurse speaking to a client at a distance of 4 feet A nurse hugging a client who had come in for an initial visit A nurse palpating the neck of a client during the assessment A nurse speaking to a depressed client in a very strict, disciplinarian tone A nurse holding the hand of a client who is depressed because of the client's child's chronic illness.

A nurse hugging a client who had come in for an initial visit A nurse speaking to a depressed client in a very strict, disciplinarian tone

Which best describes the scope of what community support services provide? 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 Crisis intervention assistance and referral

A wide range of services, from health care and education to housing arrangements, employment counseling, and rehabilitation

In what phase of the therapeutic relationship does the assessment process begin? During the initiating or orienting phase After the initiating or orienting phase has been completed During the working phase After the working phase has been completed

After the initiating or orienting phase has been completed

Which program provides comprehensive, highly individualized consumer services to those with severe and persistent mental illness? Fairweather treatment Clubhouse treatment Assertive community treatment Community living treatment

Assertive community treatment

When interviewing a young adult Asian client who immigrated to the United States as a child, the nurse best addresses the impact that culture has on the client's perceptions and beliefs by doing what? Assessing to what degree the client has embraced the American culture Asking the client to explain what the client thinks is causing the client's panic attacks Researching the physiological and emotional response to anxiety traditionally exhibited by Asians Inquiring how the client feels symptoms should be managed

Assessing to what degree the client has embraced the American culture

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? Values Knowledge Ability to relate to others Attitude

Attitude

A nurse engaged in an interaction with a client recognizes body space zones. Which would the nurse identify as the individual's personal zone? Beginning at the boundary of the intimate zone and ending at the social zone Extending outward from the border to the public zone Surrounding and protecting an individual from others, especially outsiders The most distant boundary that can be used for recognizing intruders

Beginning at the boundary of the intimate zone and ending at the social zone

Which therapeutic communication technique is being utilized when the nurse asks the client, "Is there something you'd like to talk about?" Broad openings Accepting Exploring Focusing

Broad openings

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

Case management

A client with mental illness is being discharged to a group home. The discharge planning nurse is helping the family to make the transition. The discharge planning nurse is least responsible for what related to the client's discharge? Chart review for inadequacies Family support upon discharge Past medical history Current response to treatment

Chart review for inadequacies

A client tells the mental health nurse that the client is taking a sewing class to cope with the client's son's move to another state. The use of this adaptive coping skill is an example of which aspect in the therapeutic relationship? Client self-exploration Self-disclosure Empathy Respect

Client self-exploration

A psychiatric-mental health nurse is working with several clients and decides to use silence during the interaction. In which situation would it be therapeutically appropriate to use silence? Select all that apply. Client who is experiencing depression Client who is lost in own thoughts Client who is demonstrating resistance Client who is constructing a response Client who is pondering the question

Client who is experiencing depression Client who is lost in own thoughts Client who is constructing a response Client who is pondering the question

A nurse has transferred recently to a forensic practice setting from an acute care medical setting. During the orientation period, the nurse's mentor helps the nurse learn the culture of a forensic setting. The nurse learns to be alert to one of the most dominant barriers to building a therapeutic relationship with forensic clients. What is this barrier? Clients commonly struggle with trusting others. Clients are transferred frequently to other forensic institutions. The lifestyle of the incarcerated client is solitary. Nurses often transgress professional boundaries with the clients.

Clients commonly struggle with trusting others.

Which would not be considered an impediment to successful discharge planning? Compliance with the therapeutic regimen Criminal or violent behavior Alcohol and drug abuse Noncompliance with medications

Compliance with the therapeutic regimen

A forensic nurse working in a prison must view all clients as people who deserve respect and professionalism. What should the nurse do to enforce this viewpoint? Apply the nurse's morals and values to everyone. Conduct ongoing self-reflection and self-awareness. Apply religious beliefs to patient care. Conduct thorough physical assessments of clients.

Conduct ongoing self-reflection and self-awareness.

A client expresses to the nurse that the client has been unable to sleep due to work. The nurse asks the client, "Do you mean that the work in the office is causing stress, which is why you are not able to sleep?" Which type of therapeutic communication technique is this conversation indicative of? Accepting Broad openings Consensual validation Encouraging comparison

Consensual validation

During a therapy session, the nurse states, "So you're saying that you've tried many techniques for managing your stress but haven't felt any better?" This is an example of which therapeutic communication technique? Reflecting feelings Consensual validation Focusing Offering a broad opening

Consensual validation

Which includes the circumstances or parts that clarify the meaning of the content of the message? Context Process Congruence Proxemics

Context

The same principles that define the nursing process are at work within the provision of community based mental health services through which interventions? Coordination of care Casefinder model of care Discharge planning process Reintegration process

Coordination of care

The nurse has a client who seems like the nurse's sister, with whom the nurse has a close and positive relationship. This phenomenon is best characterized by which term? Transference Free association Countertransference Reaction formation

Countertransference

Which type of cue is being used when the client states, "Nothing can help me"? Covert Overt Intentional Clear

Covert

Which term is used to refer to signals that encourage effective communication? Abstract messages Concrete messages Cue Metaphor

Cue

A client with psychiatric illness is referred to the day treatment program. Which services should the nurse include while teaching the client about the program? Select all that apply. Development of social skills. Stabilization of symptoms. Periodic prognostic tests. Training to perform activities of daily living. Treatment for comorbid conditions.

Development of social skills. Stabilization of symptoms. Training to perform activities of daily living.

The nurse is caring for a group of clients in a partial hospitalization program. The nurse would most likely be involved in which activity? Facilitating a drug abuse prevention group Providing spiritually related interventions Educating clients on menu planning and grocery shopping Teaching about the nutritional content of canned foods

Educating clients on menu planning and grocery shopping

The nurse is caring for a group of clients in a residential treatment facility. While the intensive outpatient programs promote education in the areas of stress management and relapse prevention, the residential treatment facility emphasizes what? Drug abuse prevention Spiritual aspects of care Ensuring a sustainable living situation Nutritional therapies

Ensuring a sustainable living situation

What occurs during the working phase of the nurse-client relationship? Evaluation of mutually identified goals Discussion of expectations of the relationship Assessment of client needs Discussion regarding termination of the relationship

Evaluation of mutually identified goals

After reviewing the client's chart, the nurse sets up a time to speak with the client. The client has a history of severe psychological abuse by the client's mother, who has schizophrenia. The nurse plans to ask the client about the abuse and how it has affected the client's sense of self-esteem. This is an example of what kind of intervention? Caring Excessive probing An opportunity to build trust A judgmental attitude

Excessive probing

A nurse and client are in the orientation phase of the nurse-client relationship. Which behavior would occur during this phase? Select all that apply. Explanation of the purpose of the relationship Discussion of client's expectations Identification of problems Strengthening of relationships

Explanation of the purpose of the relationship Discussion of client's expectations Discussion of client's expectations

Which is not involved in empathy? Careful listening Being in touch with what clients are saying Feeling the same emotions that the client is feeling at a given time Having insight into the meaning of clients' thoughts, feelings, and behaviors

Feeling the same emotions that the client is feeling at a given time

A nurse is engaged in a therapeutic relationship with a client. What should the nurse do in order to ensure therapeutic communication takes place? Select all that apply. Focus on the client during the interaction Use self-disclosure frequently for empathy Ensure the client's confidentiality Employ theoretically based interventions Give the client advice about what to do

Focus on the client during the interaction Ensure the client's confidentiality Employ theoretically based interventions

A nurse is engaged in a therapeutic relationship with a client. What should the nurse do in order to ensure therapeutic communication takes place? Select all that apply. Focus on the client during the interaction Use self-disclosure frequently for empathy Ensure the client's confidentiality Employ theoretically based interventions Give the client advice about what to do

Focus on the client during the interaction Ensure the client's confidentiality Employ theoretically based interventions

A group of students is reviewing the process of verbal communication. The students demonstrate understanding of the information when they identify which as the first component of the process? Formulation of an idea Message encoding Message transmission Message reception

Formulation of an idea

Which type of residential setting may care for one to three clients in a family-like atmosphere, including meals and social activities with the family? Foster homes Halfway houses Group homes Independent living

Foster homes

Which communication technique involves giving encouragement to the client, enabling continuance of the conversation and indicting that the nurse is listening? General leads Focusing Accepting Exploring

General leads

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

Giving personalized gifts to a client

The greatest impact case management has had on mental health care is that it has caused what? Has increased client access to appropriate mental health care A focus on an illness, not a health paradigm Has stimulated an interest in professional mental health careers Has affected public awareness of mental health care needs

Has increased client access to appropriate mental health care

Which theorist was most widely known for the belief that the cornerstone of all nursing care is the therapeutic relationship? Hildegard Peplau Jean Watson Florence Nightingale Clara Barton

Hildegard Peplau

The client tells the nurse, "I am regularly doing my sitting breathing exercises. Why do I still feel breathless while walking?" The nurse replies, "Sitting breathing exercises alone may not achieve the desired effects. You also should perform daily deep breathing exercises while walking. This should help you to reduce breathlessness while walking." According to the Peplau model, in which phase of the nurse-client relationship would this conversation occur? Orientation phase Identification phase Exploitation phase Termination phase

Identification phase

A psychiatric client's nurse case manager best explains to the family that case management will facilitate the client's transition back into the community by providing which services? Identifying and meeting the client's health and human service needs Contacting and maintaining relationships with the client's various service providers Facilitating reimbursement and coverage by the client's private and public insurances Prescribing nursing care directed toward managing the client's acute and chronic health problems

Identifying and meeting the client's health and human service needs

A client who is schizophrenic is catatonic and has a mask-like face. Which facial expression is being exhibited? Impassive Expressive Confusing Incongruent

Impassive

A nurse is developing a community education program for a local women's club on the topic of managed care in mental health. Which would the nurse include as the main focus? Cost savings Consistent third-party reimbursement Improved access to less costly services Individualized care for additional inpatient stays

Improved access to less costly services

A young client with severe depression and signs of hopelessness is seen in the emergency department of a large community hospital. The physician determines the need for a psychiatric consult. After the consult, the care team determines that the client is in need of hospitalization. Where should the nurse expect this client to be admitted? Psychiatric specialty unit Outpatient psychiatric care In-house psychiatric unit General medical floor

In-house psychiatric unit

Which statement is true concerning clients with dual diagnoses? Few mentally ill individuals have a confirmed dual disagoses Clients will dual diagnoses generally receive adequate treatment for both mental health issues Integrated care is preferred over split care for the separate diagnoses Intellectual disabilities are not considered as a possible dual diagnosis

Integrated care is preferred over split care for the separate diagnoses

Which are core skill areas that must be implemented by any effective team member of an interdisciplinary team? Select all that apply. Interpersonal skills Teamwork skills Communication skills Ability to work independently Risk assessment and risk management skills

Interpersonal skills Teamwork skills Communication skills Risk assessment and risk management skills

The nurse is caring for a client with schizophrenia. The client says, "Somebody is trying to kill me." The nurse responds by saying, "Isn't the weather nice? You should sit outside for a while." Which type of communication does this indicate? Interpreting Introducing an unrelated topic Making stereotyped comments Indicating the existence of an external source

Introducing an unrelated topic

The nurse is advocating for the most effective and comprehensive treatment plan for a client with bipolar disorder. The client is being held in the forensic unit of the hospital because the client has been convicted of theft. Recognizing that many factors influence the client's treatment and health maintenance after discharge, the nurse plans to do what? Request that a personality profile be performed to better understand the client's behavior. Involve an interdisciplinary team in the client's community care Determine the client's ability to function safely in public Refer aftercare planning to the patient's parole officer

Involve an interdisciplinary team in the client's community care

Which is an inaccurate statement regarding a preconception? It enables the nurse to get an accurate picture of the client's problems. It is a way that a person expects another to behave. It prevents people from getting to know one another. It may prevent the nurse from developing a therapeutic relationship with the client.

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

Which statement accurately describes the clubhouse model of community-based mental health rehabilitation? It exists to promote rehabilitation alliance. Focus is on illness, not health. Taking prescribed drugs is a condition to participation. Staff ultimately makes decisions about treatment.

It exists to promote rehabilitation alliance.

Which is accurate regarding assertive community treatment (ACT)? It offers intensive community-based services. It uses a high staff-to-client ratio. It provides day treatment programs only. It is designed to help those with mental retardation.

It offers intensive community-based services.

The nurse working in a psychiatric institution is researching treatment systems that facilitate effective learning. The nurse believes that effective milieu therapy cannot be practiced in today's institutional settings. What disadvantage related to milieu therapy may have led the nurse to believe this? It requires an open space for conducting therapy sessions. It requires clients to have longer lengths of stay. It requires the nurse to be available for care for the client all the time. It requires additional funding that may not be afforded by the institution.

It requires clients to have longer lengths of stay.

A nurse enters the room of a client who has been on the unit for several weeks. The client states, "I haven't seen you for a while. How were your days off?" What is the nurse's most appropriate response? It's important to get a break from time to time. How have the last few days been for you? I'm really not at liberty to talk about my activities outside of work. I hope you understand. I didn't do anything particularly special, but it's always nice to spend time with my family. Well, if you had to guess, what do think that I might do in my time outside of work?

It's important to get a break from time to time. How have the last few days been for you?

A client from which cultural background would most likely have an older family member present when discussing health issues with the nurse? French Australia Korean Italian

Korean

A client is discussing the client's problems at the workplace. Which nonverbal cues would indicate that the nurse is attentive to the client? Select all that apply. Looking down to the floor Leaning toward the client Mirroring the client's facial expression Maintaining eye contact with the client Sitting with closed arms and crossed legs

Leaning toward the client Maintaining eye contact with the client

A psychiatric-mental health nurse is working as a case manager. The nurse understands that the quality of case management is measured by outcomes that result from what? Improved financial status Level of functioning Emphasis on wellness Provision of the most restrictive environment

Level of functioning

Which is often more predictive of the client's success than the characteristics of his or her illness? Living environment Level of functioning Rate of reinstitutionalization Previous criminal record

Living environment

A nurse working in a psychiatric inpatient facility correctly identifies the term "milieu therapy" to mean what? Inclusion of both art therapy and psychotherapy Maintenance of the therapeutic environment A multidisciplinary approach Therapy that does not include medication

Maintenance of the therapeutic environment

Which areas of discharge planning are important to ensuring client safety? Select all that apply. Payment of care Medication education Food-drug interactions Special diet instructions Social status

Medication education Food-drug interactions Special diet instructions

The Fountain House in New York developed the clubhouse model in the 1940s. Which is an important characteristic of a clubhouse? Members receive mental health treatment from providers in the community. Membership is time limited. The clubhouse is run by staff members. Members live at the clubhouse.

Members receive mental health treatment from providers in the community.

The nursing instructor is teaching about the importance of communication in nursing and relates it to the family. Which statement by a student nurse would indicate that the teaching has not been effective? Nonverbal communication is not meaningful. Communication theory concerns the sending and receiving of verbal and nonverbal messages. All communication consists of two levels. Verbal communication is important.

Nonverbal communication is not meaningful.

Nurses are encouraged to constantly be aware of the nonverbal communication of a client with mental illness primarily for which reason? Nonverbal communication provides additional client information that is acted out unconsiously Psychiatric disorders generally affect a client's ability to communicate verbally Clients are guarded with both verbal and nonverbal communication Psychiatric disorders are more likely to affect thoughts than physical behaviors

Nonverbal communication provides additional client information that is acted out unconsiously

When clients are admitted to inpatient psychiatric settings, which member of the health care team is often the first whom they meet? Psychiatrist Case manager Nurse Social worker

Nurse

Which statement regarding those with serious and persistent mental illness (SPMI) is correct? Supplemental Security Income provides enough money for those with mental illness to pay for a home, food, and medication. Reinstitutionalization has resulted in many individuals being committed to mental hospitals and asylums. Opportunities to improve finances are limited or nonexistent because these people lack funds for education, clothing, and transportation. Medicaid funding for those with mental illness has optimized patient care for poor individuals.

Opportunities to improve finances are limited or nonexistent because these people lack funds for education, clothing, and transportation.

It is the nurse's responsibility to define the boundaries of the relationship during which phase of the nurse-client relationship? Orientation Working Termination Problem identification

Orientation

A nurse is caring for a client on an inpatient mental health unit of a hospital. The nurse tells the client, "You are scheduled to attend therapy sessions every morning at 9:00 a.m. Please make sure that you complete your morning routine, such as using the restroom, bathing, and eating breakfast, before you come for the sessions." Which phase of the nurse-client relationship does this communication indicate, according to the Peplau's model? Orientation phase Identification phase Exploitation phase Termination phase

Orientation phase

One goal of transitional care in mental health care is what? Provide intensive monitoring of the client at home Provide crisis intervention services when needed Provide an alternative for inpatient admission Encourage the parents to participate in the client's care

Provide an alternative for inpatient admission

When considering the zones of distance awareness, the nurse expects that initially the client who exhibits paranoia will be most comfortable interacting within which zone of proximity with the nurse? Public Social Intimate Personal

Public

Which zone is an acceptable distance between a speaker and an audience? Public Intimate Personal Social

Public

Which would be considered a "usual or expected" response during the first few sessions? Showing up late for the first session Being confrontational with nurse and other group members Rambling due to nervousness Bragging about sexual conquests

Rambling due to nervousness

What are some of the goals of psychiatric rehabilitation? Select all that apply. Recovery from mental illness Personal growth Increased independence Increased hospital admissions Increased involvement in treatment decisions

Recovery from mental illness Personal growth Increased independence Increased involvement in treatment decisions

Which is not a goal of the working phase of the therapeutic relationship? Reducing the client's anxieties Identifying past behaviors that have been ineffective for coping with the focal problem Increasing hopefulness for the future Developing a plan of action, practicing it, and evaluating its effectiveness

Reducing the client's anxieties

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

The parents of a client with a mental illness being cared for at home tell the nurse that they have been feeling overwhelmed lately. They say, "We need to get away for a few days to recharge ourselves." Which care setting should the nurse recommend? Respite residential care Assertive community treatment (ACT) Psychosocial rehabilitation Recovery center

Respite residential care

The parents of a young adult diagnosed with schizophrenia are providing care for the client in their home. During a home visit, the parents state, "It's been so difficult taking care of our child. We need a break. But our child needs constant supervision." Which would be appropriate for the nurse to suggest? Partial hospitalization Acute inpatient care Respite residential care Intensive outpatient program

Respite residential care

A psychiatric-mental health nurse is engaging in active listening with a client. Which technique would the nurse most likely use? Select all that apply. Changing the subject to gather more information Responding indirectly to statements Using open-ended statements Concentrating fully on what the client says Allowing the client to talk as the client wishes

Responding indirectly to statements Using open-ended statements Concentrating fully on what the client says

The case manager makes a home visit to the client's household and finds that the client has become psychotic in the prior 3 days and has bolted himself in the his room. The case manager works to encourage the client to come out and calls the ambulance to take the client to the emergency department. At what level of prevention is the case manager working? Secondary Primary Tertiary Rehabilitative

Secondary

A client is engaged in a nurse-client relationship that is in the orientation phase. With which activity would the client be involved? Seeking assistance Discussing underlying needs Testing new ways to solve problems Establishing boundaries

Seeking assistance

A psychiatric-mental health nurse is working to develop a therapeutic relationship with a client. When doing so, which element would the nurse integrate as critical to building this relationship? Self-awareness Communication skills Desire to form friendships Previous social skills

Self-awareness

A client relates that the client has panic attacks and, during the attacks, rushes to the emergency department because the client feels like the client is dying. The nurse discloses that the nurse has had panic attacks during which the nurse also felt very fearful. Which statement represents an accurate statement about this self-disclosure? Self-disclosure can help normalize the client's experience. Self-disclosure allows the client to see the nurse as a real human being. Self-disclosure can help the client feel like a friend. Self-disclosure should be detailed so the client doesn't feel unimportant or devalued.

Self-disclosure can help normalize the client's experience.

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 Services that promote the client's reintegration into the community Detoxification services for alcohol and drugs in an outpatient setting Frequent monitoring within a therapeutic milieu for relapse prevention

Services that promote the client's reintegration into the community

Which is not a primary behavior of caring, one of the core values of nursing? Giving of the self Meeting the client's needs in a timely manner Setting boundaries within the relationship Providing comfort measures to clients and their families

Setting boundaries within the relationship

Case management has been proposed as a cost-effective model of psychiatric care for mentally ill clients. Which describes the goal of case management? A return to the practice of institutionalizing chronically ill clients Short-term inpatient, crisis stabilization, and community referral Increased use of psychotropic medication to stabilize psychotic behavior quickly Infrequent use of partial hospitalization and increased use of inpatient treatment

Short-term inpatient, crisis stabilization, and community referral

Which arrangement is likely to be the least threatening to a psychiatric-mental health client? Sitting at an angle, 4 to 5 feet apart Sitting face to face, 4 to 5 feet apart Sitting at an angle, 1 to 2 feet apart Sitting face to face, 1 to 2 feet apart

Sitting at an angle, 4 to 5 feet apart

Which form of nonverbal communication would be least effective for the nurse to engage in to demonstrate interest in and acceptance of the client? Sitting behind a desk Leaning slightly forward to the client Facing the client at eye level Keeping arms and legs uncrossed

Sitting behind a desk

A mental health nurse is discussing the schedule of events for the day on the unit with a client. The nurse therapeutically communicates within which zone of distance awareness? Public Social Intimate Personal

Social

A group of nursing students is reviewing information about settings of care along the range of community care services for mental health. The students demonstrate a need for further review when they identify which as an important component of intensive outpatient programs? Social skills training Stress management education Illness education Relapse prevention

Social skills training

Which type of touch, according to Knapp, is used in greeting, such as a handshake? Social-polite Functional-professional Friendship-warmth Love-intimacy

Social-polite

A client is to be admitted to an inpatient psychiatric unit on an involuntary basis because the client has threatened to kill the client's spouse. The nurse should explain to the client's family members that the primary focus of the client's hospitalization is what? Provide long-term therapy Provide rehabilitative services Stabilize acute symptoms Provide 24-hour supervision

Stabilize acute symptoms

The nurse works for a psychiatric-mental health facility that utilizes traditional milieu therapy. Which stage of milieu therapy allows for control and limitation of maladaptive behaviors including yelling and screaming? Validation Structure Containment Involvement

Structure

During milieu therapy, nurses offer positive feedback and praise for appropriate behaviors. These actions are essential to which concept of milieu therapy? Containment Support Validation Structure

Support

The nurse explains that the primary criterion for enrollment in a day treatment program for clients with eating disorders is what? Symptom acuity does not require psychiatric hospitalization Treatment plan can be completed in less than 3 months Family home can be returned to each evening Diagnosis interferes with employability

Symptom acuity does not require psychiatric hospitalization

A client is receiving crisis stabilization in an inpatient facility. The nurse would focus care on what? Symptom stabilization Psychoeducation Discharge planning Recovery

Symptom stabilization

A patient scheduled to be released from prison in 1 month has been assigned a case manager and has been meeting with her 3 times a week. This is an example of which level of prevention? Primary Secondary Tertiary Chronic

Tertiary

A nurse is engaged in a therapeutic nurse-client relationship. The relationship is in the working phase. What does this involve? Select all that apply. Beginning to identify a need Testing new ways for problem solving Testing the relationship Discussing problems related to needs Examining personal issues

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

When engaged in a therapeutic relationship, the nurse's focus is on what? The client The self The environment The family

The client

The nurse is working with a client from the Middle East. The nurse maintains a distance of approximately 13 feet from the client while talking. The client says that the client is uncomfortable when the nurse talks to the client from such a long distance. How should the nurse interpret this statement? The client is not maintaining boundaries. The client feels that the nurse is not doing the job properly. The client feels that the nurse is indifferent toward the client. The client feels that the nurse is invading the client's personal zone.

The client feels that the nurse is indifferent toward the client.

A nurse is caring for a client with posttraumatic stress disorder. Which behavior of the client indicates the resolution phase? 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. 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.

A nurse is meeting a client for the first time. The nurse observes that the client smiles appropriately but is using rambling speech while answering the nurse's questions. Which would most likely be the reason for this behavior? The client is nervous and insecure. The client is experiencing symptoms of a disorder. The client is demonstrating a normal reaction. The client is attempting to engage in a social relationship.

The client is nervous and insecure.

A nurse recently began working with a client in the community. The client arrived 15 minutes late for the last appointment and did not show up for today's scheduled appointment, despite confirming the day before. How should the nurse best interpret this client's behavior? The client is testing the parameters of the relationship. The client is in denial about the severity of the illness. The client mistrusts the nurse's ability to promote recovery. The client's illness is being treated by another clinician.

The client is testing the parameters of the relationship.

When engaged in therapeutic communication with a client who has a mental disorder, which is the most important for a nurse to keep in mind? The nurse should self-disclose when indicated. The client is the primary focus of the interaction. The nurse should have an empathetic relationship with the client. The client's conversations should be recorded.

The client is the primary focus of the interaction.

A psychiatric-mental health nurse has entered a client's room, made an introduction, and asked if the nurse and the client could speak for a few minutes. The clients states, "Yep. Glad to talk." However, the nurse observes that the client is looking at the floor and the client's arms and legs are crossed. How should the nurse best interpret this situation? The client may be reluctant to dialogue despite the statement to the contrary The client is eager to dialogue with the nurse but is unsure how best to proceed The client is glad to talk to the nurse because that is what the client stated The disconnect between the client's verbal and nonverbal messages confirms the presence of mental illness

The client may be reluctant to dialogue despite the statement to the contrary

The nurse is sitting behind a table while speaking to a client on the other side of the table. What is the most appropriate reason for this nurse's action? The client can communicate freely. The client can open up easily. The client may have difficulty maintaining spacial boundaries. The client may be physically expressive.

The client may have difficulty maintaining spacial boundaries.

he nurse is caring for a client with severe depression. The client tells the nurse, "I really just want to sleep and not have to wake up." What may the nurse interpret from this covert cue? The client may want to sleep. The client may be extremely fatigued. The client may have suicidal ideations. The client may need a break to reduce stress.

The client may have suicidal ideations.

Which would indicate that the nurse-client relationship has passed from the orienting phase to the working phase? The client has revitalized the relationship with the client's sister. The nurse has designated a specific time each day to interact with the client. The client expresses a desire to be mothered and pampered. The client recognizes feelings of anger and expresses them appropriately.

The client recognizes feelings of anger and expresses them appropriately.

Which goal for an individual client is consistent with the overall objectives of community support service programs? The client's functional ability will improve. The client will gain insight into the causes of the client's mental illness. The client will experience fewer symptoms. The client will move from a group housing arrangement to independent living.

The client's functional ability will improve.

Which would be the least optimal environment for therapeutic communication for a client who has difficulty maintaining boundaries? The client's room An interview room A conference room The end of a hall

The client's room

Individuals may need assistance with the coordination of care and community service programs related to what? The number of hospital-based services available to clients Changes of service providers over time The number of choices of available services for specific diagnostic categories The complexity of access to the community service programs available

The complexity of access to the community service programs available

Which is inconsistent with principles of therapeutic communication? The nurse is the primary focus of the relationship. The nurse must maintain client confidentiality. Interventions are implemented from a theoretical base . A professional attitude sets the tone of the therapeutic relationship.

The nurse is the primary focus of the relationship.

During client assessment, the nurse asks the next question as soon as the client finishes answering the previous question. Which most likely explains why the nurse is interacting with the client this way? The nurse has difficulty with conducting an assessment. The nurse is accurately observing the client's nonverbal communication. The nurse may lack confidence in therapeutic communication. The nurse can gain information about the client without wasting time.

The nurse may lack confidence in therapeutic communication.

A nurse understands that giving positive regard to the client helps in building trust for the nurse. Which actions are appropriate while conveying positive regard? Select all that apply. The nurse should address the client by name. The nurse should actively listen to the client. The nurse should respond openly to the client. The nurse should be available all the time for caring for the client. The nurse should give the responsibility of planning therapy to the client.

The nurse should address the client by name. The nurse should actively listen to the client. The nurse should respond openly to the client.

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.

Which is a nurse's primary tool for treating clients with mental disorders? Psychotropic medications The therapeutic use of self Self-help groups Family education and therapy

The therapeutic use of self

A client is in need of a family-like environment with a high level of support. Which would be most appropriate? Therapeutic foster care Board-and-care home Personal care home Supervised apartment

Therapeutic foster care

Which is an inaccurate depiction of concrete questions? They require rephrasing of unclear questions. They elicit more accurate responses. They are easy to understand. There is no need for interpretation.

They require rephrasing of unclear questions.

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 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 ensure that clients comply with their medication regimens to prevent relapse To increase the community's acceptance of individuals with mental illness

To address the needs of adults with mental illness and increase their ability to function

What was the original purpose for developing the role of the case manager in community-based care? To allow the case manager to coordinate the various functions (housing, work-ups, social contacts, mental health treatment, etc.) that would address the needs of the mentally ill client within the community and reduce inpatient admissions To relieve already-burdened psychiatrists from having to make home visits to critically mentally ill clients To reduce stress on the emergency system (ie, ambulances, 911 services), which were increasingly being taxed by mentally ill individuals and their families To provide more comprehensive mental health psychotherapy to clients who were homebound

To allow the case manager to coordinate the various functions (housing, work-ups, social contacts, mental health treatment, etc.) that would address the needs of the mentally ill client within the community and reduce inpatient admissions

The psychiatric nurse recognizes that excessive social communication with a client is to be avoided primarily due to which reason? To prevent the client from viewing the nurse as a friend rather than health care provider To prevent disruption of the time that is to be used for therapeutic communication To avoid giving the client the impression that the nurse is not interested in providing effective care To avoid making the client feel that the client's problems are not viewed as being serious

To prevent the client from viewing the nurse as a friend rather than health care provider

A client begins discussing frankly the client's history of sexual abuse as a child. The nurse listens for awhile and then asks the client about the client's stressful job situation. The nurse does this for what reason? To make sure the nurse understands other problem areas in the client's life To model social skills To help the client understand appropriate boundaries To reduce the nurse's own anxiety

To reduce the nurse's own anxiety

When speaking with a client who has a diagnosis of major depression, the nurse has placed a hand lightly on the client's shoulder when responding to one of the client's statements of hopelessness. Which principle should underlie the nurse's use of touch when communicating with clients? The nurse should explicitly ask permission before touching a client in any capacity. Physical touch should be used solely with clients of the same gender as the nurse. Touch can be a powerful therapeutic tool, but it must be used with caution. Touching a client is inappropriate and opens the nurse to legal action.

Touch can be a powerful therapeutic tool, but it must be used with caution.

A nursing student is working with a client who has a history of abusing alcohol. Although the nurse has an aversive feeling toward people who abuse alcohol, the nurse feels that the client is worthy of respect and attention regardless of the nurse's own personal feelings. Which correctly describes the nurse's response to the client? Unconditional positive regard Countertransference Partnership Genuineness

Unconditional positive regard

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? Upon admission to the inpatient setting Once the client experiences an exacerbation of symptoms 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

A psychiatric-mental health nurse is conducting a self-examination of beliefs and values to develop self-awareness. Asking which question would be appropriate for the nurse to determine the fundamental personal attitudes about people of diverse cultures? Did you grow up in a rural or urban community? While a child, what attitudes did your family express about other cultures? What kinds of experiences have you had with people of other cultures? Do you think you hold bias or prejudice attitudes?

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

Which question should be avoided because it may be perceived as criticism by the client? Why? What? Where? How?

Why?

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

A psychiatric-mental health advanced practice nurse is mentoring a newly hired psychiatric-mental health nurse and role modeling therapeutic communication techniques. The advanced practice nurse observes the new nurse and determines the need for additional role modeling when the new nurse uses which technique? Select all that apply. advice reassurance disapproval silence validation

advice reassurance disapproval

Initiatives that strive to strengthen links between primary care and specialized mental health services refer to ... partial hospitalization programs. inpatient psychiatric units. psychosocial rehabilitation programs. collaborative mental health care.

collaborative mental health care.

After discussing feeling guilty about having trouble looking after her children, the client states, "They would be better off if I wasn't around." The client's statement is an example of a(n): covert cue. overt cue. abstract message. concrete message.

covert cue.

A group of nursing students is role playing situations to practice using therapeutic communication techniques. What would the students identify as verbal communication? emotion underlying the words gestures body language expressions

emotion underlying the words

While interviewing a client, the nurse imagines what it would be like to be in the client's situation and how it would feel. The nurse is demonstrating: rapport. empathy. self-awareness. projection.

empathy

A nurse is in the orientation phase of the nurse-client relationship with a client diagnosed with a mental disorder. When interviewing the client during this first encounter, which information about the client would be most important for the nurse to obtain? known allergies recent hospitalizations perception of the problem family history

perception of the problem

A nurse responds to a client's statement with silence based on the rationale that this technique is used primarily to: allow the nurse to determine an appropriate response . permit the client to gather the client's thoughts. encourage self-reflection by the nurse. demonstrate passive listening.

permit the client to gather the client's thoughts.

A nurse responds to a client's statement with silence based on the rationale that this technique is used primarily to: allow the nurse to determine an appropriate response. permit the client to gather the client's thoughts. encourage self-reflection by the nurse . demonstrate passive listening.

permit the client to gather the client's thoughts.

A student nurse is preparing for a clinical placement in a psychiatric-mental health context. In order to best prepare to engage in therapeutic communication with clients, the student should: reflect critically on the student's own life experiences, perspectives, and characteristics. diligently study the pathophysiology, epidemiology, and nursing diagnoses related to mental illness. seek out a mentor who has extensive experience in the psychiatric-mental health area. decide what aspects of the student's life and experience the student is willing to disclose to clients.

reflect critically on the student's own life experiences, perspectives, and characteristics.

What should the nurse avoid when demonstrating genuine interest for a client by making a self-disclosure? providing advice on how to manage a problem being too general with the details of the story shifting the emphasis to the nurse using situations that have occurred on the unit

shifting the emphasis to the nurse

A nurse reviews a client's psychiatric and medical history before approaching the client for an assessment. The history reveals the client has a history of sexual abuse from a caregiver in early adolescence. Which zone would be the best place for the nurse to sit the nurse to begin the assessment? intimate personal social public

social

When comparing homeless people without mental illness to homeless people with mental illness, homeless people with mental illness: spend more time in jail. spend less time in shelters. have more contact with family members. face fewer barriers to employment.

spend more time in jail.

A client diagnosed with schizophrenia is hallucinating. Which communication technique may the nurse use to redirect the client? Presenting reality Reflecting Making observations Seeking information

Presenting reality

When providing information about anorexia to a client, the nurse can ensure that the client can accurately comprehend the information by doing what? Presenting the information using language and terms the client will understand Interacting with the client in a nonthreatening, respectful manner Being careful not to overload the client with too much information at one time Giving the client ample opportunity to ask questions

Presenting the information using language and terms the client will understand

Despite family members' concerns, a client has been discharged home after a recent suicide attempt and a diagnosis of major depression. Which phenomenon has been identified as contributing to reduced lengths of hospital stays in recent years? Increased federal and state funding for psychiatric home care Pressures to reduce health care costs associated with inpatient care Improved pharmacological treatments for major depression Research suggesting that inpatient psychiatric treatment is less effective than previously believed

Pressures to reduce health care costs associated with inpatient care

The nurse is caring for a client recently diagnosed with a psychiatric illness. Which key areas should the nurse focus on while caring for this client? Select all that apply. Personal safety Preventing deterioration of mental status Promoting mental health Promoting physical health Ensuring adequate sedation with medication

Preventing deterioration of mental status Promoting mental health Promoting physical health

The goal of respite services as a prevention strategy includes what? Identifying clients who are unable to continue living in their present circumstances Preventing unnecessary long-term hospitalizations due to burnout of informal caregivers Targeting the chronic population of individuals requiring daily monitoring of their behavior and medication adherence Promoting a service to assist individuals with mental illness to achieve independent living

Preventing unnecessary long-term hospitalizations due to burnout of informal caregivers

A case manager is working with a parent whose child has schizophrenia. The parent reports sadness, frequent crying, and fatigue. The case manager works with the parent to establish some scheduled rest, relaxation, and respite from caring for the child. At which level of prevention is the case manager working with the parent? Primary Secondary Tertiary Rehabilitative

Primary

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.

A nurse is meeting with a client who just attended a group therapy session. The nurse asks, "How was group for you today?" The client is silent longer than the amount of the time the nurse expected. What can the nurse assume the client needs? more time to think to avoid the topic to discuss it at another time to disengage from the interaction

more time to think

A hospitalized client diagnosed with depression asks a nurse, "Should I go home this weekend?" Which response by the nurse uses the technique of reflection? "Should you go home for the weekend?" "Home means what to you?" "It sounds as if you don't want to go home this weekend." "I doubt that you really should go home this weekend."

"Should you go home for the weekend?"

Which statement is the most empathic response to a client's disclosure that the client's father abandoned the family when the client was a young child? "That must have been terribly hurtful experience for you." "I too have been disappointed by important people in my life." "You will find that one of the constants in life is that people will often let you down." "What do you think motivated your father to do that."

"That must have been terribly hurtful experience for you."

Which statement would indicate that the nurse has a non-judgmental attitude? "People who are mentally ill have basically weak characters." "The client has struggled with her life circumstance of living with a man who beats her, and she is trying very hard to make the changes necessary to help herself." "I think the client is exaggerating her feelings so she can leave work early." "Mental illnesses are, for the most part, all in your head and could be solved more easily if people were forced to continue with their daily activities, instead of listening to their complaints."

"The client has struggled with her life circumstance of living with a man who beats her, and she is trying very hard to make the changes necessary to help herself."

A nurse has approached a new client on the psychiatric care unit in order to establish a therapeutic relationship and conduct a focused assessment. As the nurse approaches the client, the client says, "Oh good. Here comes one more person to tell me that I'm crazy." Which of the nurse's following responses would constitute countertransference? "Is that a message you've been hearing a lot over the past couple of days?" "It sounds like you're exasperated with the caregivers you've interacted with. Is that fair to say?" "Actually, I've not come here to tell you that." "There's no need to get rude with me. I'm just trying to do my job and to help you out."

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

Choose the most therapeutic response to the client's statement, "All I feel like doing is screaming as loudly as I can." "Please calm down; everything is going to be better." "Who has made you so upset?" "I wish you could try to be more positive." "You look like you are very angry this morning."

"You look like you are very angry this morning."

Which statement by the nurse reflects the use of a therapeutic statement? "You look upset. Would you like to talk about it?" "I'd like to know more about your children. Tell me about them." "I understand your husband passed away. I couldn't bear that." "You look very sad. How long have you been this way? Have you been taking care of yourself?"

"You look upset. Would you like to talk about it?"

A nurse is speaking to a client who attempted suicide. The client says, "It is my dream to become a doctor, and I failed the entrance exam. I am so mad at myself." Which statement indicates genuine interest by the nurse? "You were killing yourself for this?" "You must have been really upset." "What would you gain by killing yourself?" "It is wrong to commit suicide."

"You must have been really upset."

A nurse is speaking to a client with a soft smile and eye contact. Which statement said by the nurse would indicate a congruent message? "Please don't disturb the other clients in the ward." "Your hard work and determination has helped you recover." "Please listen to the instructions carefully before starting the exercises." "I know you are in pain. Please wait until the medication shows its effect."

"Your hard work and determination has helped you recover."

A client who has tried several different antidepressant medications tells the nurse that uncomfortable side effects make the client want to stop taking medication altogether. What is the nurse's best response? "If you think that is best for you, I agree." "Antidepressants rarely have side effects." "All of our clients have some side effects and they manage okay." 'Tell me what is it about the medication that is troubling you the most."

'Tell me what is it about the medication that is troubling you the most."

A nursing instructor is teaching a class about transitional psychiatric care. The instructor determines that additional education is needed when the class identifies which client as appropriate for this care? A 43-year-old recovering from acute psychoses A 34-year-old with severe and persistent mental illness A 52-year-old with AIDS dementia A 42-year-old who would like to enter marriage counseling

A 42-year-old who would like to enter marriage counseling

A client was diagnosed with bipolar I disorder several years ago. After occasional inpatient admissions surrounding manic episodes over the past few years, the client has been receiving outpatient psychiatric services for the past 12 months. The client's care providers, however, are concerned that these outpatient services are not meeting the client's needs. Which service would best fit this client's needs at this time? A day-treatment program Admission to a long-term care facility Subacute care Rehabilitative care

A day-treatment program

Which clinical situation provides an example of transference? A nurse implements the same interventions with multiple clients despite their personal differences. A nurse asks for clarification from a colleague when explaining a coping strategy to a client. A client mirrors the nursing student's nervousness and hesitancy during assessment. A female client with a history of sexual abuse exhibits a profound mistrust of male caregivers.

A female client with a history of sexual abuse exhibits a profound mistrust of male caregivers.

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 depression associated 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? Countertransference A judgmental attitude Exploitation Poor boundaries

A judgmental attitude

A client has recently been diagnosed with cancer. The client says, "What did I do wrong to get such a disease?" Which nonverbal processes, along with the client's statement, would convey a congruent message? Select all that apply. A sad facial expression A cheerful expression A fearful tone of voice A sarcastic tone of voice An erect, confident posture

A sad facial expression A fearful tone of voice

A nursing student is preparing for a debate with another student about e-mental health. Which would the nurse include to support its use? Ability to provide services in a variety of locations Improvement in therapeutic relationship Ensured quality of care Ability to provide high-intensive services for many mental illnesses

Ability to provide services in a variety of locations

"Get the stuff from him" is an example of which type of message? Abstract Concrete Clear Direct

Abstract

During the orientation phase of a nurse-client relationship, the nurse notes a change in the client's behavior. The client has forgotten a scheduled session and then accuses the nurse of breaking confidentiality. The nurse interprets this as suggesting what? Acting out Rejection of the nurse Dissatisfaction with the care Lack of understanding of the plan

Acting out

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

Acute inpatient hospitalization

Which client is suitable for psychiatric transitional care services? Paralyzed Vietnam veteran who is experiencing increasing respiratory difficulties and chronic infections Schizophrenic woman found living under the freeway Adolescent with conduct disorder who took an overdose of alprazolam An individual being discharged from hospital with residual symptoms of mania

An individual being discharged from hospital with residual symptoms of mania

Which verbal cue refers to accents on words or phrases that highlight the subject or give insight on the topic? Emphasis Tone Pitch Intensity

Emphasis

A nurse is caring for a client with anxiety disorder. The nurse knows that the client will have dyspnea and tachycardia if she has an anxiety attack. According to the Carper's patterns of nursing knowledge, which pattern of knowing is this indicative of? Ethical knowing Aesthetic knowing Personal knowing Empirical knowing

Empirical knowing

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? Empower clients to achieve the highest level of functioning possible 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

A nurse is assessing a client with chronic illness. The client is whimpering. The nurse asks the client, "Is something wrong?" Which type of therapeutic communication technique is this indicative of? Exploring Focusing Encouraging expression Encouraging description of perception

Encouraging description of perception

Which is a primary goal of community mental health care? Emphasize crisis intervention and stabilize clients receiving psychotropic medications. Engage clients to help determine need, policy changes, and evolution of mental health programs. Provide mandated care to clients of all ages in the least restrictive settings. Place chronically ill clients in comfortable family-like settings.

Engage clients to help determine need, policy changes, and evolution of mental health programs.

When interacting with a client for the first time, which information would be appropriate for the nurse to disclose? Select all that apply. Name Level of education Home address Family members Reason for being on the unit

Name Level of education Reason for being on the unit

When the nurse helps the cognitively impaired client bathe and dress, what role is the nurse assuming? Parent surrogate Advocate Caregiver Teacher

Parent surrogate

Which type of setting is used for clients who continue to need supervision but not long-term admission? Partial (day) hospitalization Acute care Voluntary commitment Nursing home

Partial (day) hospitalization

The client is a 54-year-old who is addicted to drugs and alcohol. Which setting would be best for an individual in need of support to minimize the risk of repeat hospitalizations? Long-term hospitalization Acute care hospital Partial hospitalization program Outpatient care

Partial hospitalization program

A nurse is reviewing information about the various types of outpatient mental health care programs. The nurse demonstrates understanding by identifying which type as providing the most intensive outpatient nursing care? Partial hospitalization programs Crisis intervention programs Outpatient detoxification programs Rehabilitation programs

Partial hospitalization programs

Which mental health treatment setting is not a residential treatment setting? Partial hospitalization programs Group homes Adult foster care Respite

Partial hospitalization programs

Which would be most important for the nurse to do in order to maximize client adherence with the discharge plan? Telling the client to adhere to the plan Partnering with the client from the beginning Encouraging the client to ask for help Monitoring the client continuously

Partnering with the client from the beginning

A nurse who has worked with a client with post-traumatic stress disorder (PTSD) regularly for several months stares blankly at the nurse for a long time. The nurse understands that the client is dissociating. According to the Carper's patterns of nursing knowledge, which pattern of knowing is this indicative of? Ethical knowing Aesthetic knowing Personal knowing Empirical knowing

Personal knowing

A nurse is assessing an adolescent client who has recently been self-mutilating. The nurse asks the client questions that seek to uncover the motivation underlying the behavior. The nurse's approach best reflects what? The use of unconditional positive regard A demonstration of genuine interest The therapeutic use of self The exploration of behaviors to uncover the client perspective

The exploration of behaviors to uncover the client perspective

A college's nursing program has added an elective in forensic nursing to the curriculum. Which phenomenon underlies the expanded role for forensic nursing that is expected in the future? The fact that most crimes are committed by people who have mental illness The fact that people with mental illness are the most common victims of crime The fact that there are high rates of mental illness among the populations of jails and prisons The fact that many states now require all prison inmates to be assessed by a mental nurse daily

The fact that there are high rates of mental illness among the populations of jails and prisons

Which observation should lead the nurse manager to recognize that countertransference is affecting the therapeutic effectiveness of an individual nurse on the unit? The nurse frequently refers to an elderly, cognitively impaired client as "my granny" The nurse is referred to as being in a relationship with a client by that client, and the client wants the nurse to accompany the client to the prom The nurse begins to experience the symptoms of depression and calls out sick The nurse asks to be transferred to another unit to avoid burnout and to work with different disorders

The nurse frequently refers to an elderly, cognitively impaired client as "my granny"

A client with a history of depression has told the nurse that the client is feeling especially "low" this morning. The nurse has responded by stating, "Try thinking about some of the blessings you have in your life." How should the nurse's statement be best interpreted? The nurse has inhibited therapeutic communication by giving advice The nurse made an inappropriate suggestion because it was not preceded by assessment The nurse has inhibited the nurse-client relationship by challenging the client The nurse has violated the ethical principles of beneficence and nonmaleficence

The nurse has inhibited therapeutic communication by giving advice

A client expresses worry about the client's child's aggressive behavior. The nurse says "You are in a very challenging situation. Your child's aggressive behavior is very stressful for you, is this correct?" What does this nurse's statement indicate? The nurse is comforting the client. The nurse is empathizing with the client. The nurse is sympathizing with the client. The nurse is showing genuine interest in the client.

The nurse is empathizing with the client.

A nursing student is caring for a client who has been arrested for child abuse. The nurse is very curious about what the client must have done to get into so much trouble, so the nurse asks the client to tell the nurse about the various activities that got the client arrested. This is an example of: lack of awareness. genuineness and caring. gathering assessment data. excessive probing.

excessive probing.

Which nursing intervention demonstrates congruence in a therapeutic nurse-client relationship? getting an appointment with the client at the time previously agreed upon discussing the client's request for additional privileges with the treatment team sharing examples of stress management techniques implementing restatement as a therapeutic communication method

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