N3381 Exam 1 Practice Questions
A new graduate nurse has accepted a staff position at an inpatient mental health facility. The graduate nurse can expect to be responsible for basic-level functions, including: a. Providing clinical supervision. b. Using effective communication skills. c. Adjusting client medications. d. Directing program development.
b. Using effective communication skills. Explanation: basic-level functions include using effective communication skills, milieu therapy, self-care activities, psychobiological interventions, health teaching, case management, and health promotion and maintenance. Advanced-level functions include psychotherapy, prescriptive authority for drugs, consultation and liaison, evaluation, program development and management, and clinical supervision.
The nurse presents a class about mental health and mental illness to a group of fourth graders. One student asks, "Why do people get mentally ill?" The nurse's best response is: a. "There are many reasons why mental illness occurs." b. "The cause of mental illness is complicated and very hard to understand." c. "Sometimes a person's brain does not work correctly because something bad happens or they inherit a brain problem." d. "Most mental illnesses result from genetically transmitted abnormalities in cerebral structure; however, some are a consequence of traumatic life experiences."
c. "Sometimes a person's brain does not work correctly because something bad happens or they inherit a brain problem." Explanation: the nurse answers rather than evades the question, provides accurate information, and uses terminology a 9 or 10-year-old child can understand. Many of the most prevalent and disabling mental disorders have been found to have strong biological influences, including genetic transmission.
An adolescent asks a nurse conducting an assessment interview, "Why should I tell you anything? You'll just tell my parents whatever you find out." What is the nurse's best reply regarding patient confidentiality? a. "That is not true. What you tell us is private and held in strict confidence. Your parents have no right to know." b. "Yes, your parents may find out what you say, but it is important that they know about your problems." c. "What you say about feelings is private, but some things, like suicidal thinking, must be reported to the treatment team." d. "It sounds as though you are not really ready to work on your problems and make changes."
c. "What you say about feelings is private, but some things, like suicidal thinking, must be reported to the treatment team." Explanation: the patient has a right to know that most information will be held in confidence but that certain material must be reported or shared with the treatment team, such as threats of suicide, homicide, use of illegal drugs, or issues of abuse. The first response is not strictly true. The second response will not inspire the confidence of the patient. The fourth response is confrontational.
A nurse assesses a new patient whose chief concern is "daily crying spells." Which comment from the patient would prompt the nurse to suspect a medical reason is causing the problem rather than depression? a. "I usually drink two or three cups of coffee in the morning." b. "I often have headaches, especially when the pollen count is high." c. "Years ago I had thyroid problems but they cleared up so I stopped the medicine." d. "I recently had three moles removed because my doctor thought they were suspicious."
c. "Years ago I had thyroid problems but they cleared up so I stopped the medicine." Explanation: the patient's thyroid problems may have re-emerged and can mimic depression.
A patient tells the nurse, "I don't think I'll ever get out of here." Select the nurse's most therapeutic response. a. "Don't talk that way, of course you will leave here!" b. "Keep up the good work, and you certainly will." c. "You don't think you're making progress?" d. "Everyone feels that way sometimes."
c. "You don't think you're making progress?" Explanation: by asking if the patient does not believe that progress has been made, the nurse is reflecting or paraphrasing by putting into words what the patient is hinting. By making communication more explicit, issues are easier to identify and resolve. The remaining options are non-therapeutic techniques. Telling the patient not to "talk that way" is disapproving. Saying that everyone feels that way at times minimizes feelings. Telling the patient that good work will always result in success is falsely reassuring.
Which scenario meets the criteria for "normal" behavior? a. An 8-year-old child's only verbalization is "No no no." b. A 16-year-old girl usually sleeps for 3 or 4 hours per night. c. A 43-year-old man cries privately for 1 month after the death of his wife. d. A 64-year-old woman has difficulty remembering the names of her children.
c. A 43-year-old man cries privately for 1 month after the death of his wife. Explanation: the death of a spouse is a difficult experience, so crying is expected and thus 'normal.' Many biological, cultural, and environmental factors influence mental health. Further, persons who are "normal" may also experience dysfunction during their lives.
The nurse knows the written instructions for healthcare when a person is incapacitated is called: a. Living will b. Durable Power of Attorney c. Advance directive d. Informed consent
c. Advance directive Explanation: advance care directives are written instructions for healthcare when individuals are incapacitated. For people who are gravely disabled ; are found to be incompetent; cannot provide food, clothing, and shelter for themselves even when resources exist; and cannot act in their own best interests may require advance care directives and/or may require appointment of a conservator or legal guardian.
A nurse participating in a community health fair interviews an adult who has had no interaction with a healthcare professional for more than 10 years. The adult says, "I like to keep to myself. Crowds make me nervous." Which action should the nurse employ? a. Refer the adult for a full health assessment. b. Explore the adult's family and social relationships. c. Ask the adult, "how do you feel about the quality of your life?" d. Explain to the adult, "we can help you feel better about yourself."
c. Ask the adult, "how do you feel about the quality of your life?" Explanation: it's important for the nurse to continue to assess the adult, respect the adult's individuality, and delay judgment regarding whether the person is experiencing illness. Avoiding crowds may be an effective coping technique for this patient.
A client underwent a procedure before the nurse verified the client's signature on the consent form. The client actually did not sign the form before the procedure. If the client is dissatisfied with the outcome of the procedure and files a suit against the health care team, which kind of case can the client file? a. Negligence b. Malpractice c. Battery d. False Imprisonment
c. Battery Explanation: battery involves harmful or unwarranted contact with a client. False imprisonment is defined as the unjustifiable detention of a client, such as the inappropriate use of restraint or seclusion. Negligence is an unintentional tort that involves causing harm by failing to do what a reasonable and prudent person would do in similar circumstances. Clients or families can file malpractice lawsuits in any case of injury, loss, or death.
Operant conditioning will be used to encourage speech in a child who is nearly mute. Which technique would a nurse include in the treatment plan? a. Ignore the child for using silence. b. Have the child observe others talking. c. Give the child a small treat for speaking. d. Teach the child relaxation techniques, then coax speech.
c. Give the child a small treat for speaking. Explanation: operant conditioning involves giving positive reinforcement for a desired behavior. Treats are rewards to reinforce speech. Ignoring the child will not change the behavior. Having the child observe others describes modeling. Teaching relaxation techniques and then coaxing speech is an example of systematic desensitization.
Two hospitalized patients resort to physical fighting when they are in the same room. During a team meeting, a nurse asserts that safety is of paramount importance and therefore the treatment plans should call for both patients to be secluded to prevent them from injuring each other. Which does this assertion indicate about the nurse who presented it? a. Reveals that the nurse has a strong sense of justice. b. Values the reinforcement of the autonomy of the two patients. c. Has a poor understanding of the civil rights of the two patients. d. Doesn't understand the actions that constitute the intentional tort of battery.
c. Has a poor understanding of the civil rights of the two patients. Explanation: patients have a right to treatment in the least restrictive setting. Less restrictive measures should be tried first. Unnecessary seclusion may result in a charge of false imprisonment. Seclusion removes the patient's autonomy. The principle by which the nurse is motivated is beneficence, not justice. The tort represented is false imprisonment, not battery.
The nurse plans care for a newly hospitalized patient experiencing panic-level anxiety after an automobile accident. The patient has no physical injuries. When selecting goals from the Nursing Outcomes Classification (NOC), the nurse will: a. Select outcomes related to patient learning. b. Focus first on the long-term goals for the patient. c. Individualize outcomes based on the patient's needs. d. Confer with the patient about which outcomes the patient wants to achieve.
c. Individualize outcomes based on the patient's needs. Explanation: while it is important to confer with the patient about which outcomes are desirable, a patient experiencing panic is unable to engage in decision making or learning activities. Outcomes, as well as interventions, must always be individualized to the patient.
A nurse wishes to teach alternative coping strategies to a patient experiencing severe anxiety. The nurse will first need to: a. Verify the patient's learning style. b. Create outcomes and a teaching plan. c. Lower the patient's current anxiety level. d. Assess how the patient uses defense mechanisms.
c. Lower the patient's current anxiety level. Explanation: a patient experiencing severe anxiety has a significantly narrowed perceptual field and difficulty attending to events in the environment. A patient experiencing severe anxiety will not learn readily. Determining preferred modes of learning, devising outcomes, and constructing teaching plans are relevant to the task but are not the priority measure. The nurse has already assessed the patient's anxiety level. Using defense mechanisms does not apply.
Which belief by a nurse supports the highest degree of patient advocacy during a multidisciplinary patient care planning session? a. All mental illnesses are culturally determined. b. Schizophrenia and bipolar disorder are cross-cultural disorders. c. Some symptoms of mental disorders may reflect a person's cultural patterns. d. Symptoms of mental disorders are constant from culture to culture.
c. Some symptoms of mental disorders may reflect a person's cultural patterns. Explanation: a nurse who understands that a patient's symptoms are influenced by culture will be able to advocate for the patient to a greater degree than a nurse who believes that culture is of little relevance. All mental illnesses are not culturally determined. Schizophrenia and bipolar disorder are cross-cultural disorders, but this understanding has little relevance to patient advocacy. Symptoms of mental disorders change from culture to culture.
A client with a long history of mental illness was declared incompetent several months ago. What aspects of the client's current condition provide the legal basis for a change to competence? Select all that apply. a. The client is able to state when he was originally declared incompetent b. The client expresses a clear desire for the change in legal status c. The client is able to summarize the proposed treatment plan d. The client is able to discuss the rationale for the treatment plan with the care team e. The client expresses an understanding of his disease and the factors that exacerbate it
c. The client is able to summarize the proposed treatment plan d. The client is able to discuss the rationale for the treatment plan with the care team e. The client expresses an understanding of his disease and the factors that exacerbate it Explanation: summarizing the components and rationale for the treatment plan indicate the client understands important information and appreciates his situation. Similarly, his description of the disease and symptom triggers shows competent thinking. Identifying the date when he was declared incompetent and wanting to have a change in status do not strengthen the legal case for a change in status.
A nurse assesses a patient with a tentative diagnosis of generalized anxiety disorder. Which question would be most appropriate for the nurse to ask? a. "Have you been a victim of a crime or seen someone badly injured or killed b. "Do you feel especially uncomfortable in social situations involving people? c. "Do you repeatedly do certain things over and over again?" d. "Do you find it difficult to control your worrying?"
d. "Do you find it difficult to control your worrying?" Explanation: patients with generalized anxiety disorder frequently engage in excessive worrying. They are less likely to engage in ritualistic behavior, fear social situations, or have been involved in a highly traumatic event.
A nurse assesses a newly admitted patient diagnosed with major depressive disorder. Which statement is an example of "attending"? a. "We all have stress in life. Being in a psychiatric hospital is not the end of the world." b. "Tell me why you felt you had to be hospitalized to receive treatment for your depression." c. "You will feel better after we get some antidepressant medication started for you." d. "I'd like to sit with you for a while, so you may feel more comfortable talking with me."
d. "I'd like to sit with you for a while, so you may feel more comfortable talking with me." Explanation: attending is a technique that demonstrates the nurse's commitment to the relationship and reduces feelings of isolation. This technique shows respect for the patient and demonstrates caring. Generalizations, probing, and false reassurances are nontherapeutic.
An 86-year-old, previously healthy and independent, falls after an episode of vertigo. Which statement made by this patient best demonstrates resilience? a. "I knew this would happen eventually." b. "Attending my weekly water aerobics class is too risky." c. "I don't need that silly walker to get around by myself." d. "Maybe some physical therapy will help me with my balance."
d. "Maybe some physical therapy will help me with my balance." Explanation: resiliency is the ability to recover from or adjust to misfortune and change. The correct response indicates that the patient is hopeful and thinking positively about ways to adapt to the vertigo. Saying "I knew this would happen eventually" and discontinuing healthy activities suggest a hopeless perspective on the health change. Refusing to use a walker indicates denial.
The parent of an adult diagnosed with severe and persistent mental illness asks the nurse, "why are you making a referral to that vocational rehabilitation program? My child won't ever be able to hold a job." Which is the nurse's best reply? a. "We made this referral to maintain eligibility for federal funding." b. "Are you concerned that we're trying to make your child too independent?" c. "If you think the program would be detrimental, we can postpone it for a time." d. "Most patients are capable of employment at some level, competitive or supported."
d. "Most patients are capable of employment at some level, competitive or supported." Explanation: studies have shown that most patients who complete vocational rehabilitation programs are capable of some level of employment; also, they demonstrate significant improvement in assertiveness and work behaviors, as well as decreased depression, and improved self-esteem and socialization.
An informal group of patients discuss their perceptions of nursing care. Which comment best indicates a patient's perception that his or her nurse is caring? a. "My nurse always asks me which type of juice I want to help me swallow my medication." b. "My nurse explained my treatment plan to me and asked for my ideas about how to make it better." c. "My nurse told me that if I take all the medicines the doctor prescribes, I will get discharged soon." d. "My nurse spends time listening to me talk about my problems. That helps me feel like I'm not alone."
d. "My nurse spends time listening to me talk about my problems. That helps me feel like I'm not alone." Explanation: caring evidences empathic understanding as well as competency. It helps change pain and suffering into a shared experience, creating a human connection that alleviates feelings of isolation. The incorrect options give examples of statements that demonstrate advocacy or giving advice.
The parent of an adolescent diagnosed with schizophrenia asks a nurse, "My child's doctor ordered a positron-emission tomography (PET) scan. What is that?" What is the nurse's best response? a. "PET uses a magnetic field and gamma waves to identify problems areas in the brain. Does your teenager have any metal implants?" b. "It's a special type of x-ray image that shows structures of the brain and whether a brain injury has ever occurred." c. "PET is a scan that passes an electrical current through the brain and shows brain wave activity. PET can help diagnose seizures." d. "PET is a special scan that shows blood flow and activity in the brain."
d. "PET is a special scan that shows blood flow and activity in the brain." Explanation: the parent is seeking information about PET scans. It is important to use terms the parent can understand. The correct option is the only reply that provides factual information relevant to PET scans. The incorrect responses describe magnetic resonance imaging (MRI), computed tomographic (CT) scans, and electroencephalography (EEG).
Cognitive behavioral therapy was provided for a patient who frequently said, "I'm stupid." Which statement by the patient indicates the therapy was effective? a. "I'm disappointed in my lack of ability." b. "I always fail when I try new things." c. "Things always go wrong for me." d. "Sometimes I do stupid things."
d. "Sometimes I do stupid things." Explanation: "I'm stupid" is a cognitive distortion or irrational thought. A more rational thought is, "sometimes I do stupid things." The latter thinking promotes emotional self-control. The incorrect options reflect irrational thinking.
A school-age child tells the school nurse, "other kids call me mean names and will not sit with me at lunch. Nobody likes me." Select the nurse's most therapeutic response. a. "Just ignore them and they will leave you alone." b. "You should make friends with other children." c. "Call them names if they do that to you." d. "Tell me more about how you feel."
d. "Tell me more about how you feel." Explanation: the correct response uses exploring, a therapeutic technique. The distractors give advice, which is a non-therapeutic technique.
A critical care nurse asks a psychiatric nurse about the difference between a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and a nursing diagnosis. What is the psychiatric nurse's best response? a. "No functional difference exists between the two diagnoses. Both serve to identify a human deviance." b. "The DSM-5 diagnosis disregards culture, whereas the nursing diagnosis includes cultural variables." c. "The DSM-5 diagnosis profiles present distress or disability, whereas a nursing diagnosis considers past and present responses to actual mental health problems." d. "The DSM-5 diagnosis influences the medical treatment; the nursing diagnosis offers a framework to identify interventions for problems a patient has or may experience."
d. "The DSM-5 diagnosis influences the medical treatment; the nursing diagnosis offers a framework to identify interventions for problems a patient has or may experience." Explanation: the medical diagnosis, defined according to the DSM-5, is concerned with the patient's disease state, causes, and cures, whereas the nursing diagnosis focuses on the patient's response to stress and possible caring interventions. Both the DSM-5 and a nursing diagnosis consider culture. Nursing diagnoses also consider potential problems.
Which comment by the nurse would be appropriate to begin a new nurse-patient relationship? a. "Which of your problems is most serious?" b. "I want you to tell me about your problems." c. "I'm an experienced nurse. You can trust me." d. "What would you like to tell me about yourself?"
d. "What would you like to tell me about yourself?" Explanation: the correct response is respectful and recognizes that trust between the nurse and patient needs to be developed. The correct response is also open ended, which is an appropriate communication technique to begin a new relationship.
A nurse counsels a widow whose husband died 5 years ago. The widow says, "if I'd done more, he would still be alive." Select the nurse's response that reflects presenting reality. a. "I understand how you feel after such a terrible loss." b. "That was a long time ago. Now it's time to move on with your life." c. "You did a very good job of caring for him, especially since he was sick so long." d. "Your husband was 82 years old with severe chronic obstructive pulmonary disease."
d. "Your husband was 82 years old with severe chronic obstructive pulmonary disease." Explanation: the correct response demonstrates the therapeutic technique of presenting reality. Giving advice, disagreeing, and changing the subject are non-therapeutic communication techniques.
Which scenario is an example of a tort? a. The primary nurse completes the plan of care for a patient but takes a full 24 hours after the admission to do so. b. An advanced practice nurse recommends that a patient who has a history of danger to self and others be voluntarily hospitalized when reporting audio hallucinations. c. A patient's admission status is changed from involuntary to voluntary after the patient's hallucinations subside after medication is started. d. A nurse gives an as-needed dose of an antipsychotic drug to a patient to prevent any possible violence because the unit is short staffed.
d. A nurse gives an as-needed dose of an antipsychotic drug to a patient to prevent any possible violence because the unit is short staffed. Explanation: a tort is a civil wrong against a person that violates his or her rights. Giving unnecessary medication for the convenience of staff members controls behavior in a manner similar to secluding a patient; thus, false imprisonment is a possible charge. None of the other options exemplify a tort since none violates a patient's rights.
An adult says, "when I was a child, I took medication because I couldn't follow my teachers' directions. I stopped taking it when I was about 13. I still have trouble getting organized, which causes difficulty at my job." Which disorder is most likely? a. Stress intolerance disorder b. Generalized anxiety disorder (GAD) c. Borderline personality disorder d. Adult attention-deficit/hyperactivity disorder (ADHD)
d. Adult attention-deficit/hyperactivity disorder (ADHD) Explanation: adult ADHD is usually diagnosed in early life and treated until adolescence. Treatment is often stopped because professionals think the disorder resolves itself because the hyperactive impulsive behaviors may diminish; the inattentive and disorganized behaviors tend to persist, however. Stress intolerance disorder is not found in the DSM-5. The scenario description is inconsistent with generalized anxiety disorder and borderline personality disorder.
In a staff meeting at an inpatient mental health facility, the administrator announces that psychiatric technicians will now be supervised by the milieu director rather than by nurses. What is the nurse's best action? a. Confer with colleagues about their opinions regarding the proposed change. b. Volunteer to participate on a committee charged with defining job responsibilities of unlicensed assistive personnel. c. Ask the administrator to delay implementation of this change until the decision can be reviewed by an interdisciplinary team. d. Advise the administrator of regulations in the state nurse practice act regarding supervision of unlicensed assistive personnel.
d. Advise the administrator of regulations in the state nurse practice act regarding supervision of unlicensed assistive personnel. Explanation: state nurse practice acts specify that unlicensed assistive personnel (UAP) work under a nurse's supervision. Institutional policies and practices do not remove the nurse of responsibility to practice on the basis of professional standards of nursing care.
A patient diagnosed with severe and persistent mental illness who recently moved to a homeless shelter says, "my life is out of control. I'm like a leaf at the mercy of the wind." The nurse formulates the diagnosis Powerlessness. Outcomes will focus on which goal? a. Instilling hope b. Controlling anxiety c. Planning social activities d. Developing personal autonomy
d. Developing personal autonomy Explanation: powerlessness is associated with feeling unable to control events in one's life. It is often associated with low self-esteem. The goal is to increase one's sense of autonomy. The scenario does not indicate hopelessness or anxiety. Socialization is not the primary need.
A patient demonstrates disorganized thinking associated related to a diagnosis of schizophrenia. Neuroimaging would most likely show dysfunction in which part of the brain? a. Brainstem b. Cerebellum c. Temporal lobe d. Prefrontal cortex
d. Prefrontal cortex Explanation: the prefrontal cortex is responsible for intellectual functioning. The temporal lobe is responsible for the sensation of hearing. The cerebellum regulates skeletal muscle coordination and equilibrium. The brainstem regulates internal organs.
For a patient experiencing a panic attack, which nursing intervention should be implemented first? a. Teach relaxation techniques. b. Administer an anxiolytic medication. c. Prepare to implement physical controls. d. Provide calm, brief, directive communication.
d. Provide calm, brief, directive communication. Explanation: calm, brief, directive verbal interaction can help the patient gain control of overwhelming feelings and impulses related to anxiety. Patients experiencing panic-level anxiety are unable to focus on reality; thus, learning relaxation techniques is virtually impossible. Administering anxiolytic medication should be considered if providing calm, brief, directive communication is ineffective. Although the patient is disorganized, violence may not be imminent, ruling out the intervention of preparing for physical control until other less-restrictive measures are proven ineffective.
A 55-year-old lives 100 miles from her parents and mother-in-law. In the past year, her father had back surgery, her mother broke her hip, and her mother-in-law had a cardiac event. Which nursing diagnosis is most applicable to the 55-year-old? a. Risk for complicated grieving related to impending deaths of parents b. Risk for injury related to frequent long drives to care for aging parents c. Risk for chronic low self-esteem related to overwhelming responsibilities d. Risk for caregiver role strain related to responsibilities for care of aging parents
d. Risk for caregiver role strain related to responsibilities for care of aging parents Explanation: the focus of the question is the caregiver. Demands associated with the care of three elderly persons who live at a distance have the potential of overwhelming the caregiver. Because there is no evidence of role strain, a risk diagnosis is formulated.
A patient tells the nurse, "no matter what I do, I feel like there's always a dark cloud following me." Select the nurse's initial action. a. Assess the patient's current sleep and eating patterns. b. Explain to the patient, "everyone feels down from time to time." c. Suggest alternative activities for times when the patient feels depressed. d. Say to the patient, "tell me more about what you mean by 'a dark cloud'."
d. Say to the patient, "tell me more about what you mean by 'a dark cloud'." Explanation: the correct response accomplishes two results: the nurse can further assess the patient's complaint and the nurse uses clarification, a therapeutic communication technique.
An outpatient psychiatric nurse assesses a patient diagnosed with hoarding disorder. The patient has lost 12 pounds in the past two months, appears disheveled, and is wearing dirty clothing with poor hygiene. What is the nurse's priority action? a. Review the patient's medication regimen. b. Ask the patient, "What types of foods have you been eating?" c. Refer the patient to a psychologist for cognitive behavioral therapy (CBT). d. Schedule a home visit to assess the safety of the patient's living conditions.
d. Schedule a home visit to assess the safety of the patient's living conditions. Explanation: safety is the nurse's first priority. Individuals diagnosed with hoarding disorder often live in unsafe conditions. A home visit will help to identify whether safety is the primary concern.
What would be an indication that the above client is demonstrating more adaptive behavior? a. Behaves without considering the consequences of personal actions. b. Aggressively meets own needs without considering the rights of others. c. Seeks help from others when assuming responsibility for major areas of own life. d. Sees self as capable of achieving ideals and meeting demands.
d. Sees self as capable of achieving ideals and meeting demands. Explanation: A, B, and C are maladaptive behaviors. D describes an adaptive healthy behavior.
The nursing process consists of the following: Assessment, Diagnosis, Planning, Intervention, Evaluation. True or False?
True. Assessment Diagnosis (prioritize problems from assessment data) Plan (outcomes, goals) Intervention (nursing interventions to help patient achieve goals/outcome) Evaluation (were goals met, outcomes achieved through successful interventions)
A patient has been out of work 3 weeks with a major illness and anticipates another month of recovery. The patient tells the nurse, "I'm trying to keep up with my work email from home. They hired a new person in my department, but the person has no experience." Select the nurse's therapeutic response. a. "It sounds like you're saying you are worried about your job security." b. "No one expects you to keep pace with your job while you're recovering." c. "Your employer is required to hold your job for you while you're on sick leave." d. "Don't worry about your job right now. It's more important for you to recover."
a. "It sounds like you're saying you are worried about your job security." Explanation: the correct response demonstrates the therapeutic technique of reflection.
A student nurse tells the instructor, "I don't need to interact with my patients. I learn what I need to know by observation." The instructor can best interpret the nursing implications of Sullivan's theory by providing what response? a. "Nurses cannot be isolated. We must interact to provide patients with opportunities to practice interpersonal skills." b. "Observing patient interactions can help you formulate priority nursing diagnoses and appropriate interventions." c. "I wonder how accurate your assessment of the patient's needs can be if you do not interact with the patient." d. "Noting patient behavioral changes is important because these signify changes in personality."
a. "Nurses cannot be isolated. We must interact to provide patients with opportunities to practice interpersonal skills." Explanation: Sullivan believed that the nurse's role includes educating patients and assisting them in developing effective interpersonal relationships. Mutuality, respect for the patient, unconditional acceptance, and empathy are cornerstones of Sullivan's theory. The nurse who does not interact with the patient cannot demonstrate these cornerstones. Observations provide only objective data. Priority nursing diagnoses usually cannot be accurately established without subjective data from the patient. The third response pertains to Maslow's theory. The fourth response pertains to behavioral theory.
Which statement shows a nurse has empathy for a patient who made a suicide attempt? a. "You must have been very upset when you tried to hurt yourself." b. "It makes me sad to see you going through such a difficult experience." c. "If you tell me what is troubling you, I can help you solve your problems." d. "Suicide is a drastic solution to a problem that may not be such a serious matter."
a. "You must have been very upset when you tried to hurt yourself." Explanation: empathy permits the nurse to see an event from the patient's perspective, understand the patient's feelings, and communicate this to the patient. The incorrect responses are nurse centered (focusing on the nurse's feelings rather than the patient's), belittling, and sympathetic.
Which scenario best demonstrates empathetic caring? a. A nurse provides comfort to a colleague after an error of medication administration. b. A nurse works a fourth extra shift in 1 week to maintain adequate unit staffing. c. A nurse identifies a violation of confidentiality and makes a report to an agency's privacy officer. d. A nurse conscientiously reads current literature to stay aware of new evidence-based practices.
a. A nurse provides comfort to a colleague after an error of medication administration. Explanation: empathetic caring is evidenced by understanding, by actions, and patience with others. It is also defined by the act of giving of self.
Which economic factors are most critical to the success of discharge planning for a patient diagnosed with severe and persistent mental illness? Select all that apply. a. Access to housing b. Individual psychotherapy c. Availability of income to meet basic needs d. Availability of health insurance e. Availability of transportation to the med clinic
a. Access to housing c. Availability of income to meet basic needs d. Availability of health insurance e. Availability of transportation to the med clinic Explanation: the success of discharge planning requires careful attention to the patient's economic status. Access to housing is the first priority of the seriously mentally ill, and lack of income and health insurance is a barrier to effective treatment and rehabilitation. Although important aspects of ongoing care of the seriously mentally ill patient, ongoing interdisciplinary evaluation and individual psychotherapy are not economic factors. Availability of transportation to the medication clinic is crucial to ensure this client adheres to medication protocols.
The psychiatric mental health nurse is caring for a female client with obsessive compulsive disorder. Which action using the science of nursing by the nurse, best addresses the likely etiology of this client's disease? a. Administering escitalopram as prescribed b. Encouraging the client to talk about her childhood experiences c. Facilitating the client's social interaction in the context of a support group d. Teaching the client progressive relaxation techniques
a. Administering escitalopram as prescribed Explanation: administering medication falls into the science of nursing. The evidence suggests a biochemical etiology for OCD. Specifically, deficient levels of serotonin have been implicated. Childhood trauma and social isolation are not significant etiologic factors. Anxiety is a symptom of the problem, not an etiologic factor.
What information should be included when teaching a patient about their new prescription for lorazepam? Select all that apply. a. Caution in use of machinery b. Foods allowed on a tyramine-free diet c. The importance of caffeine restriction d. Avoidance of alcohol and other sedatives e. Take the medication on an empty stomach
a. Caution in use of machinery c. The importance of caffeine restriction d. Avoidance of alcohol and other sedatives Explanation: caffeine is a central nervous system stimulant that acts as an antagonist to the benzodiazepine lorazepam. Daily caffeine intake should be reduced to the amount contained in one cup of coffee. Benzodiazepines are sedatives, thus the importance of exercising caution when driving or using machinery and the importance of not using other central nervous system depressants such as alcohol or sedatives to avoid potentiation. Benzodiazepines do not require a special diet. Food will reduce gastric irritation from the medication.
A client is diagnosed with obsessive-compulsive disorder (OCD) and is to receive medication therapy. Which of the following agents might the nurse expect to be prescribed? Select all that apply. a. Clomipramine b. Lithium c. Sertraline d. Fluvoxamine e. Paroxetine f. Alprazolam
a. Clomipramine c. Sertraline d. Fluvoxamine e. Paroxetine Explanation: selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) are considered to be the most effective treatment agents used for OCD. SSRI's will be the 1st line treatment. TCA's have increased side effects so not our first choice. Clomipramine was the first drug to produce significant advances in treating people with OCD. Other medications have proved effective, including sertraline, fluoxetine, fluvoxamine, and paroxetine. Lithium is used to treat bipolar disorder. Alprazolam may be used to treat acute, short-term for panic.
After teaching a class about the biological theories associated with panic disorder, the group leader determines a need for additional education when the group identifies which neurotransmitter as being implicated? a. Dopamine b. Serotonin c. Norepinephrine d. Gamma-aminobutyric acid (GABA)
a. Dopamine Explanation: biochemical theories suggest involvement of serotonin, norepinephrine, and GABA in panic disorder. Dopamine is not associated with this condition.
A day shift nurse contacts a nurse scheduled for night shift at home and says, "our unit is full and there are eight patients in the emergency department waiting for a bed." The night shift nurse replies, "thanks for telling me. I am calling in sick." Which type of problem is evident by the night shift nurse's reply? a. Ethical problem of fidelity b. Legal problem of negligence c. Legal problem of an intentional tort d. Violation of the patient's' right to treatment
a. Ethical problem of fidelity Explanation: fidelity is an ethical principle that involves maintaining loyalty and commitment to patients.
A student says, "before taking a test, I feel very alert and a little restless." Which nursing intervention is most appropriate to assist the student? a. Explain that the symptoms result from mild anxiety and discuss the helpful aspects. b. Advise the student to discuss this experience with a health care provider. c. Encourage the student to begin antioxidant vitamin supplements. d. Listen attentively, using silence in a therapeutic way.
a. Explain that the symptoms result from mild anxiety and discuss the helpful aspects. Explanation: teaching about symptoms of anxiety, their relation to precipitating stressors, and, in this case, the positive effects of anxiety will serve to reassure the patient. Advising the student to discuss the experience with a health care provider implies that the student has a serious problem. Listening without comment will do no harm but deprives the student of health teaching. Antioxidant vitamin supplements are not useful in this scenario.
Which is inconsistent with an evidence-based approach? a. Nurse-centered decision making b. Clinical questions are defined c. Outcomes are evaluated d. Application of research findings
a. Nurse-centered decision making Explanation: in an evidence-based approach, clinical questions are defined, evidence is discovered and analyzed, the research findings are applied in a practical manner and in collaboration with the client, and outcomes are evaluated. This approach requires using competent literature search skills, followed by careful reading and critiquing of the studies.
The nurse should assess a patient taking a drug with anticholinergic properties for inhibited function of the: a. Parasympathetic nervous system. b. Sympathetic nervous system. c. Reticular activating system. d. Medulla oblongata.
a. Parasympathetic nervous system. Explanation: acetylcholine is the neurotransmitter found in high concentration in the parasympathetic nervous system. When anticholinergic drugs inhibit acetylcholine action, blurred vision, dry mouth, constipation, and urinary retention commonly occur.
An adult patient tells the case manager, "I don't have bipolar disorder anymore, so I don't need medicine. After I was in the hospital last year, you helped me get an apartment and disability checks. Now I'm bored and don't have any friends." Which resources should the nurse suggest for the patient? Select all that apply. a. Psychoeducation classes b. Vocational rehabilitation c. Social skills training d. Homeless shelter e. Crisis intervention
a. Psychoeducation classes b. Vocational rehabilitation c. Social skills training Explanation: the patient doesn't understand the illness and the need for adhering to the medication regimen. Psychoeducation for the patient (and family) can address this lack of knowledge. Work gives meaning and purpose to life; vocational rehabilitation can assist with this aspect of care. The patient, who considers himself friendless, could also profit from social skills training to improve the quality of interpersonal relationships. Many patients with severe mental illness have such poor communication skills that others are uncomfortable interacting with them. Interactional skills can be effectively taught by breaking down each skill into small verbal and nonverbal components. The patient presently has a home and does not require the services of a homeless shelter. The nurse case manager functions in the role of crisis stabilizer, so no related referral is needed.
What drug classifications are prescribed to treat the symptoms of obsessive-compulsive disorder and related anxiety disorders? a. Selective serotonin reuptake inhibitors b. Benzodiazepines c. Atypical antipsychotics d. Serotonin Norepinephrine Reuptake Inhibitors
a. Selective serotonin reuptake inhibitors Explanation: selective serotonin reuptake inhibitors are used to treat obsessive compulsive disorders.
Which of the following is not a function of acetylcholine? a. Slowing digestion b. Slowing heart rate c. Muscle contraction d. Memory
a. Slowing digestion Explanation: as part of the parasympathetic nervous system, acetylcholine will increase digestion, not slow it down. Slowing heart rate and muscle contraction and memory are all correctly identified as functions of acetylcholine.
Which information should a nurse include in health teaching for adults diagnosed with attention-deficit/hyperactivity disorder (ADHD) and their significant others? Select all that apply. a. Tendency for genetic transmission. b. Prevention strategies related to substance abuse. c. Negative reinforcement strategies to help modify behaviors. d. Selective serotonin reuptake inhibitors (SSRIs) are usually prescribed. e. Cognitive therapy may help resolve negative beliefs about self.
a. Tendency for genetic transmission. b. Prevention strategies related to substance abuse. e. Cognitive therapy may help resolve negative beliefs about self. Explanation: evidence suggests that ADHD has a biological basis. This fact can help adults with the disorder to cope with low self-esteem. Cognitive therapy is helpful in reframing negative beliefs about self. Adults diagnosed with ADHD have a higher incidence of substance abuse problems. Psychostimulant medications, rather than SSRIs, are usually prescribed.
When preparing information for a community education program on the mentally ill in the community, the nurse plans to address the common misconceptions about persons with mental illness. Which misconceptions would the nurse most likely address? Select all that apply. a. They are on government-assisted programs b. They are aggressive and violent c. They are confused or otherwise cognitively impaired d. They are unable to care for themselves e. They are poorly educated
a. They are on government-assisted programs b. They are aggressive and violent c. They are confused or otherwise cognitively impaired d. They are unable to care for themselves Explanation: psychiatric clients are often mistakenly stereotyped or categorized by the public as being poor, violent, confused, and unable to care for themselves. Lack of education is not necessarily a common publicly held stereotype of the mentally ill.
Paraphilic disorders involve: a. Unacceptable sexual fantasies that may cause distress, risk, or harm to self or others. b. Normal sexual urges c. Biological, psychological, and social risk factors d. Antidepressants, Naltrexone, and mood stabilizers
a. Unacceptable sexual fantasies that may cause distress, risk, or harm to self or others. c. Biological, psychological, and social risk factors Explanation: unlike normal sexual urges, which may consist of sexual fantasies that deviate from the conventional but considered normal if no distress occurs, a paraphilic disorder causes distress, risk or harm to self or others. A patient with a paraphilic disorder may or may not act out those fantasies. There are biological, psychological, and social risk factors for developing paraphilias. Paraphilias respond to Naltrexone, SSRIs, and specific therapies.
A drug causes muscarinic receptor blockade. The nurse will assess the patient for: a. Urinary hesitancy. b. Gynecomastia. c. Pseudoparkinsonism. d. Orthostatic hypotension.
a. Urinary hesitancy. Explanation: muscarinic receptor blockade includes atropine-like side effects, such as urinary hesitancy, dry mouth, blurred vision, and constipation. Gynecomastia is associated with increased prolactin levels. Movement defects are associated with dopamine blockade. Orthostatic hypotension is associated with á1 antagonism.
Considering Maslow's pyramid, which comment indicates an individual is motivated by the highest level of need? a. "Even though I'm 40 years old, I have returned to college so I can get a better job." b. "I help my community by volunteering at a thrift shop that raises money for the poor." c. "I recently applied for public assistance in order to feed my family, but I hope it's not forever." d. "My children tell me I'm a good parent. I feel happy being part of a family that appreciates me."
b. "I help my community by volunteering at a thrift shop that raises money for the poor." Explanation: Maslow's hierarchy of needs are placed on a pyramid, with the most basic and important needs on the lower level. The higher levels, of the pyramid are the more specific human needs, and individuals must meet the lower-levels before moving to the next level. Self-actualization and esthetics are the highest-level needs.
A patient diagnosed with schizophrenia tells the nurse, "the CIA is monitoring us through the fluorescent lights in this room. Be careful what you say." Which response by the nurse would be most therapeutic? a. "Let's talk about something other than the CIA." b. "It sounds like you're concerned about your privacy." c. "The CIA is prohibited from operating in health care facilities." d. "You have lost touch with reality, which is a symptom of your illness."
b. "It sounds like you're concerned about your privacy." Explanation: Iit is important not to challenge the patient's beliefs, even if they are unrealistic. Challenging undermines the patient's trust in the nurse. The nurse should try to understand the underlying feelings or thoughts the patient's message conveys. The correct response uses the therapeutic technique of reflection. The other comments are nontherapeutic. Asking to talk about something other than the concern at hand is changing the subject. Saying that the CIA is prohibited from operating in health care facilities gives false reassurance. Stating that the patient has lost touch with reality is truthful but uncompassionate.
A patient asks a nurse, "What are neurotransmitters? My doctor says mine are out of balance." What is the nurse's best response? a. "You must feel relieved to know that your problem has a physical basis." b. "Neurotransmitters are chemicals that pass messages between brain cells." c. "It is a high-level concept to explain. You should ask the doctor to tell you more." d. "Neurotransmitters are substances we eat daily that influence memory and mood."
b. "Neurotransmitters are chemicals that pass messages between brain cells." Explanation: stating that neurotransmitters are chemicals that pass messages between brain cells gives the most accurate information. Neurotransmitters are messengers in the central nervous system. They are released from the axon terminal, diffuse across the synapse, and attach to specialized receptors on the postsynaptic neuron. The incorrect responses do not answer the patient's question, are demeaning, and provide untrue and misleading information.
Which entry in the medical record best meets the requirement for problem-oriented charting? a. "A: Pacing and muttering to self. P: Sensory perceptual alteration, related to internal auditory stimulation. I: Given fluphenazine 2.5 mg at 0900 and went to room to lie down. E: Calmer by 0930. Returned to lounge to watch TV." b. "S: States, 'I feel like I'm ready to blow up.' O: Pacing hall, mumbling to self. A: Auditory hallucinations. P: Offer haloperidol 2 mg. I: haloperidol 2 mg at 0900. E: Returned to lounge at 0930 and quietly watched TV." c. "Agitated behavior. D: Patient muttering to self as though answering an unseen person. A: Given haloperidol 2 mg and went to room to lie down. E: Patient calmer. Returned to lounge to watch T d. "Pacing hall and muttering to self as though answering an unseen person. haloperidol 2 mg administered at 0900 with calming effect in 30 minutes. Stated, 'I'm no longer bothered by the voices.'"
b. "S: States, 'I feel like I'm ready to blow up.' O: Pacing hall, mumbling to self. A: Auditory hallucinations. P: Offer haloperidol 2 mg. I: haloperidol 2 mg at 0900. E: Returned to lounge at 0930 and quietly watched TV." Explanation: problem-oriented documentation uses the first letter of keywords to organize data: S for subjective data, O for objective data, A for assessment, P for plan, I for intervention, and E for evaluation. The distractors offer examples of PIE charting, focus documentation, and narrative documentation.
An adult experiencing a recent exacerbation of ulcerative colitis tells the nurse, "I had an accident while I was at the grocery store. It was so embarrassing." Select the nurse's therapeutic response. a. "Most grocery stores have public restrooms available." b. "Tell me more about how you felt when that happened." c. "Why didn't you use the restroom before you left the house?" d. "Have you considered using a product for incontinence?"
b. "Tell me more about how you felt when that happened." Explanation: the correct response encourages description and helps the patient to express their feelings related to this experience. The other responses are not therapeutic.
In which scenario is it most urgent for the nurse to act as a patient advocate? a. An adult cries and experiences anxiety after a near-miss automobile accident on the way to work. b. A homeless adult diagnosed with schizophrenia lives in a community expecting a category 5 hurricane. c. A 14-year-old girl's grades decline because she consistently focuses on her appearance and social networking. d. A parent allows the prescription to lapse for 1 day for their 8-year-old child's medication for attention-deficit/hyperactivity disorder.
b. A homeless adult diagnosed with schizophrenia lives in a community expecting a category 5 hurricane. Explanation: while all of the scenarios present opportunities for a nurse to intervene, the correct response presents an imminent danger to the patient's safety and well-being.
Which nursing intervention demonstrates false imprisonment? a. A confused and combative patient says, "I'm getting out of here and no one can stop me." The nurse restrains this patient without a health care provider's order and then promptly obtains an order. b. A patient has been irritating, seeking the attention of nurses most of the day. Now a nurse escorts the patient down the hall, saying, "stay in your room or you'll be put in seclusion." c. An involuntarily hospitalized patient with suicidal ideation runs out of the psychiatric unit. A nurse rushes after the patient and convinces the patient to return to the unit. d. An involuntarily hospitalized patient with suicidal ideation attempts to leave the unit. A nurse calls the security team and uses established protocols.
b. A patient has been irritating, seeking the attention of nurses most of the day. Now a nurse escorts the patient down the hall, saying, "stay in your room or you'll be put in seclusion." Explanation: false imprisonment involves holding a competent person against his or her will. Actual force is not a requirement of false imprisonment. The individual needs only to be placed in fear of imprisonment by someone who has the ability to carry out the threat. The patient in one distractor is not competent, and the nurse is acting beneficently. The patients in the other distractors have been admitted as involuntary patients and should not be allowed to leave without permission of the treatment team.
What action should a nurse take when unintentionally making an inappropriate or awkward statement to a client? a. Acknowledge that the misstatement was a result of being anxious. b. Clarify by saying, "that wasn't what I meant to say." c. Defuse the situation by assuring the client that "I was just kidding." d. Ignore the error, since no one is expected to be perfect.
b. Clarify by saying, "that wasn't what I meant to say." Explanation: no one magic phrase can solve a client's problems; likewise, no single statement can significantly worsen them. Listening carefully, showing genuine interest, and caring about the client are extremely important. A nurse who possesses these elements but says something that sounds out of place can simply restate it by saying, "That didn't come out right. What I meant was..." Pretending that the nurse did not say it, stating that it was a joke, and ignoring the error are not likely to help the nurse build and maintain credibility with the client.
A client admitted is assessed and evaluated at an inpatient behavioral health hospital. What behavior indicates that the client has a mental illness? a. Client is able to see the difference between the 'as if' and the 'for real.' b. Client describes mood as consistently sad, discouraged and hopeless. c. Client responds to rules, norms and customs of their culture. d. Given limitations, client can perform tasks they are given.
b. Client describes mood as consistently sad, discouraged and hopeless. Explanation: A, C, and D describe mentally healthy behavior; B describes a mood disorder.
A nurse assesses a confused older adult. The nurse experiences sadness and reflects, "the patient is like one of my grandparents, so helpless." What feelings does the nurse describe? a. Transference b. Countertransference c. Catastrophic reaction d. Defensive coping reaction
b. Countertransference Explanation: countertransference is the nurse's transference or response to a patient that is based on the nurse's unconscious needs, conflicts, problems, or view of the world.
A patient who is preparing for surgery has moderate anxiety and is unable to understand preoperative information. Which nursing intervention is appropriate? a. Reassure the patient that all nurses are skilled in providing postoperative care. b. Describe the procedure again in a calm manner, using simple language. c. Tell the patient that the staff is prepared to promote recovery. d. Encourage the patient to express feelings to his or her family.
b. Describe the procedure again in a calm manner, using simple language. Explanation: providing information in a calm, simple manner helps the patient grasp the important facts. Introducing extraneous topics as described in the incorrect options will further scatter the patient's attention.
Extrapyramidal side effects are the result of which one of the following? a. Too much serotonin b. Dopamine blocking c. Too little serotonin d. Too few receptors
b. Dopamine blocking Explanation: extrapyramidal side effects is a drug induced movement disorder related to blocking D2 (dopamine) receptors.
A patient taking an antipsychotic medication develops restlessness and an uncontrollable need to be in motion. A nurse can correctly analyze that these symptoms are related to which drug action? a. Anticholinergic effects b. Dopamine-blocking effects c. Endocrine-stimulating effects d. Ability to stimulate spinal nerves
b. Dopamine-blocking effects Explanation: medications that block dopamine often produce disturbances of movement (extrapyramidal side effects) such as akathisia because dopamine affects neurons involved in both the thought processes and movement regulation. Anticholinergic effects include dry mouth, blurred vision, urinary retention, and constipation. Akathisia is not caused by endocrine stimulation or spinal nerve stimulation.
A psychiatric-mental health nurse is implementing evidence-based practice. The nurse understands that this approach is developed by doing what first? a. Conducting research b. Identifying a clinical question c. Determining outcomes d. Collaborating with the client
b. Identifying a clinical question Explanation: in an evidence-based approach, first clinical questions are defined. Then evidence is discovered and analyzed. Next the research findings are applied in a practical manner and in collaboration with the client, and outcomes are evaluated.
The therapeutic action of neurotransmitter inhibitors that block reuptake cause: a. Decreased concentration of the blocked neurotransmitter in the central nervous system. b. Increased concentration of the blocked neurotransmitter in the synaptic gap. c. Destruction of receptor sites specific to the blocked neurotransmitter. d. Limbic system stimulation.
b. Increased concentration of the blocked neurotransmitter in the synaptic gap. Explanation: if the reuptake of a substance is inhibited, it accumulates in the synaptic gap, and its concentration increases, permitting ease of transmission of impulses across the synaptic gap. Normal transmission of impulses across synaptic gaps is consistent with normal rather than depressed mood. The other options are not associated with blocking neurotransmitter reuptake.
Friends invite an adult diagnosed with type 2 diabetes to go on a mountain hike next week. The adult replies, "I can't go because I don't have any hiking shoes." In actuality, this adult fears difficulty with blood glucose management during strenuous activity. Which defense mechanism is evident? a. Displacement b. Rationalization c. Passive aggression d. Reaction formation
b. Rationalization Explanation: rationalization refers to justifying an action to satisfy the listener.
A nurse is assessing a client with anxiety and observes the client yelling and screaming. The nurse, integrating Peplau's theory, interprets this behavior as: a. Panic behaviors. b. Relief behaviors. c. Empathetic linkage. d. Social distance.
b. Relief behaviors. Explanation: according to Peplau, behavioral cues related to the levels of anxiety are "relief behaviors." Panic is the most severe form of anxiety manifested by an inability to function. Empathetic linkage is the ability to feel in oneself the feelings experienced by another person. Social distance is a concept associated with formal and informal support systems. It is the degree to which the values of the formal support organization and primary group members differ.
A neighbor telephones the nurse daily, giving lengthy details about multiple somatic complaints and relationship problems. Which limit-setting strategy should the nurse employ? a. Suggest the neighbor call other people in the community. b. Say to the neighbor, "I can talk to you for 15 minutes twice a week." c. Use the telephone's caller identification to screen calls from the neighbor. d. Tell the neighbor, "You should discuss these concerns with your personal physician rather than me."
b. Say to the neighbor, "I can talk to you for 15 minutes twice a week." Explanation: the nurse has a responsibility for self-care and must set limits on the neighbor's intrusive calls. Specifying the frequency and time allotment for calls shows compassion for the neighbor while preventing infringement on the nurse's personal life.
During the first interview with a parent whose child died in a car accident, the nurse feels empathic and reaches out to take the patient's hand. Select the correct analysis of the nurse's behavior. a. It shows empathy and compassion. It will encourage the patient to continue to express feelings b. The gesture is premature. The patient's cultural and individual interpretation of touch is unknown. c. The patient will perceive the gesture as intrusive and overstepping boundaries. d. The action is inappropriate. Psychiatric patients should not be touched.
b. The gesture is premature. The patient's cultural and individual interpretation of touch is unknown. Explanation: touch has various cultural and individual interpretations. Nurses should refrain from using touch until an assessment is completed regarding the way in which the patient will perceive touch. The incorrect options present prematurely drawn conclusions.
A nurse plans a group meeting for adult patients in a therapeutic milieu. Which topic should the nurse include? a. Coping with grief and loss b. The importance of hand washing c. Strategies for money management d. Staffing shortages expected over the next 3 days
b. The importance of hand washing Explanation: a 'therapeutic milieu' (concept attributed to Harry Stack Sullivan) provides a healthy social structure within an inpatient setting or structured outpatient clinic. Groups aim to help increase patients' self-esteem, decrease social isolation, encourage appropriate social behaviors, and educate patients in basic living skills, thus the importance of hand washing would be addressed.
