Psych Ch. 1, 2, 4

A client repeatedly stated, "I'm stupid." Which statement by that client would show progress resulting from cognitive-behavioral therapy? a. "Sometimes I do stupid things." b. "Things always go wrong for me." c. "I always fail when I try new things." d. I'm disappointed in my lack of ability."

ANS: A "I'm stupid" is a cognitive distortion. A more rational thought is "Sometimes I do stupid things." The latter thinking promotes emotional self-control. The distracters reflect irrational or distorted thinking. This item relates to an audience response question.

A nurse makes an initial visit to a homebound client diagnosed with a serious mental illness. A family member offers the nurse a cup of coffee. What is the nurse's best response? a. "Thank you. I would enjoy having a cup of coffee with you." b. "Thank you, but I would prefer to proceed with the assessment." c. "No but thank you. I never accept drinks from clients or families." b. "Our agency policy prohibits me from eating or drinking in clients' homes."

ANS: A Accepting refreshments or chatting informally with the client and family represent therapeutic use of self and help to establish rapport. the distracters fail to help establish rapport.

Which technique is most applicable to aversion therapy? a. Punishment b. Desensitization c. Role modeling d. Positive reinforcement

ANS: A Aversion therapy is akin to punishment. Aversive techniques include pairing of a maladaptive behavior with a noxious stimulus, punishment, and avoidance training.

In-client hospitalization for persons with mental illness is generally reserved for clients who demonstrate which characteristic? a. present a clear danger to self or others. b. are noncompliant with medication at home. c. have limited support systems in the community. d. develop new symptoms during the course of an illness.

ANS: A Hospitalization is justified when the client is a danger to self or others, has dangerously decompensated, or needs intensive medical treatment. the distracters do not necessarily describe clients who require inpatient treatment.

A community mental health nurse has worked for months to establish a relationship with a delusional, suspicious client. the client recently lost employment and could no longer afford prescribed medications. the client says, "Only a traitor would make me go to the hospital." What is the nurse's best initial intervention? a. With the client's consent, contact resources to provide medications without charge temporarily. b. Arrange a bed in a local homeless shelter with nightly on-site supervision. c. Hospitalize the client until the symptoms have stabilized. d. Ask the client, "Do you feel like I am a traitor?"

ANS: A Hospitalization may damage the nurse-client relationship, even if it provides an opportunity for rapid stabilization. If medication is restarted, the client may possibly be stabilized in the home setting, even if it takes a little longer. Programs are available to help clients who are unable to afford their medications. A homeless shelter is inappropriate and unnecessary. Hospitalization may be necessary later, but a less restrictive solution should be tried first, since the client is not dangerous. A yes/no question is non-therapeutic communication.

Which finding best indicates that the goal "Demonstrate mentally healthy behavior" was achieved for an adult client? a. being willing to work towards achieving ideals and meeting demands. b. behaving without considering the consequences of personal actions. c. aggressively meeting personal needs without considering the rights of others. d. seeking help from others to avoid assuming responsibility for major areas of own life.

ANS: A Mental health is a state of well-being in which individuals reach their own potential, cope with the normal stresses of life, work productively, and contribute to the community. Mental health provides people with the capacity for rational thinking, communication skills, learning, emotional growth, resilience, and self-esteem. The correct response describes an adaptive, healthy behavior. The distracters describe maladaptive behaviors.

What action is an example of tertiary prevention? a. Helping a person diagnosed with a serious mental illness learn to manage money b. Restraining an agitated client who has become aggressive and assaultive c. Teaching school-age children about the dangers of drugs and alcohol d. Genetic counseling with a young couple expecting their first child

ANS: A Tertiary prevention involves services that address residual impairments, with a goal of improved independent functioning. Restraint is a secondary prevention. Genetic counseling and teaching school-age children about substance abuse and dependence are examples of primary prevention.

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

ANS: A The behaviors in the stem develop as the result of attitudes formed during the oral stage, when an infant first learns to relate to the environment. Anal-stage traits include stinginess, stubbornness, orderliness, or their opposites. Phallic-stage traits include flirtatiousness, pride, vanity, difficulty with authority figures, and difficulties with sexual identity. Genital-stage traits include the ability to form satisfying sexual and emotional relationships with members of the opposite sex, emancipation from parents, a strong sense of personal identity, or the opposites of these traits.

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

ANS: A The best candidates for psychodynamic therapy are relatively healthy and well-functioning individuals, sometimes referred to as the ―worried well,‖ who have a clearly circumscribed area of difficulty and are intelligent, psychologically minded, and well-motivated for change. Clients with psychosis, severe depression, borderline personality disorders, and severe character disorders are not appropriate candidates for this type of treatment.

A nurse performed these actions while caring for clients in an inpatient psychiatric setting. Which action violated clients' rights? a. Prohibited a client from using the telephone b. In client's presence, opened a package mailed to client c. Remained within arm's length of client with homicidal ideation d. Permitted a client with psychosis to refuse oral psychotropic medication

ANS: A The client has a right to use the telephone. the client should be protected against possible harm to self or others. Clients have rights to send and receive mail and be present during package inspection. Clients have rights to refuse treatment.

A nurse surveying medical records would find evidence suggesting which client's rights have been violated? a. A client was not allowed to have visitors. b. A client's belongings were searched at admission. c. A client with suicidal ideation was placed on continuous observation. d. Physical restraint was used after a client was assaultive toward a staff member.

ANS: A The client has the right to have visitors. Inspecting clients' belongings is a safety measure. Clients have the right to a safe environment, including the right to be protected against impulses to harm self.

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

ANS: A The id operates on the pleasure principle, seeking immediate gratification of impulses. The ego acts as a mediator of behavior and weighs the consequences of the action, perhaps determining that taking the toy is not worth the mother's wrath. The superego would oppose the impulsive behavior as ―not nice.‖ The preconscious is a level of awareness rather than an aspect of personality.

A nurse uses Maslow's hierarchy of needs to plan care for a client diagnosed with mental illness. Which problem will receive priority? a. Refusal to eat or bathe. b. Reporting feelings of alienation from family. c. Reluctance to participate in unit social activities. d. Being unaware of medication action and side effects.

ANS: A The need for food and hygiene are physiological and therefore take priority over psychological or meta-needs in care planning.

A client diagnosed with schizophrenia has been stable for 2 months. Today the client's spouse calls the nurse to report the client has not taken prescribed medication and is having disorganized thinking. the client forgot to refill the prescription. the nurse arranges a refill. What is the best outcome to add to the plan of care? a. The client's spouse will mark dates for prescription refills on the family calendar. b. The nurse will obtain prescription refills every 90 days and deliver to the client. c. The client will call the nurse weekly to discuss medication-related issues. d. The client will report to the clinic for medication follow-up every week.

ANS: A The nurse should use the client's support system to meet client needs whenever possible. Delivery of medication by the nurse should be unnecessary for the nurse to do if client or a significant other can be responsible. the client may not need more intensive follow-up as long as medication is taken as prescribed.

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

ANS: A The question asks about risk. Hearing voices is generally associated with mental illness, but in charismatic religious groups, hearing the voice of God or a prophet is a desirable event. Cultural norms vary, which makes it more difficult to make an accurate diagnosis. The individuals described in the other options are less likely to be labeled mentally ill.

Which principle has the highest priority when addressing a behavioral crisis in an inpatient setting? a. Resolve the crisis with the least restrictive intervention possible. b. Swift intervention is justified to maintain the integrity of a therapeutic milieu. c. Rights of an individual client are superseded by the rights of the majority of clients. d. Clients should have opportunities to regain control without intervention if the safety of others is not compromised.

ANS: A The rule of using the least restrictive treatment or intervention possible to achieve the desired outcome is the client's legal right. Planned interventions are nearly always preferable. Intervention may be necessary when the client threatens harm to self.

Consider this comment from a therapist: "The client is homosexual but has kept this preference secret. Severe anxiety and depression occur when the client anticipates family reactions to this sexual orientation." Which perspective is evident in the speaker? a. Theory of interpersonal relationships b. Classical conditioning theory c. Psychosexual theory d. Behaviorism theory

ANS: A The theory of interpersonal relationships recognizes the anxiety and depression as resulting from unmet interpersonal security needs. Behaviorism and classical conditioning theories do not apply. A psychosexual formulation would focus on uncovering unconscious material that relates to the client problem

Which scenario best depicts a behavioral crisis? a. A client is waving fists, cursing, and shouting threats at a nurse. b. A client is curled up in a corner of the bathroom, wrapped in a towel. c. A client is crying hysterically after receiving a phone call from a family member. d. A client is performing push-ups in the middle of the hall, forcing others to walk around.

ANS: A This behavior constitutes a behavioral crisis because the client is threatening harm to another individual. Intervention is called for to defuse the situation. the other options speak of behaviors that may require intervention of a less urgent nature because the clients in question are not threatening harm to self or others.

An experienced nurse says to a new graduate, "When you've practiced as long as I have, you automatically know how to take care of clients experiencing psychosis." Which factors should the new graduate consider when analyzing this comment? (Select all that apply.) a. The experienced nurse may have lost sight of clients' individuality, which may compromise the integrity of practice. b. New research findings should be integrated continuously into a nurse's practice to provide the most effective care. c. Experience provides mental health nurses with the essential tools and skills needed for effective professional practice. d. Experienced psychiatric nurses have learned the best ways to care for mentally ill clients through trial and error. e. An intuitive sense of clients' needs guides effective psychiatric nurses.

ANS: A, B Evidence-based practice involves using research findings and standards of care to provide the most effective nursing care. Evidence is continuously emerging, so nurses cannot rely solely on experience. The effective nurse also maintains respect for each client as an individual. Overgeneralization compromises that perspective. Intuition and trial and error are unsystematic approaches to care.

A nurse can best address factors of critical importance to successful community treatment by including making assessments focused on what? (Select all that apply.) a. housing adequacy. b. family and support systems. c. income adequacy and stability. d. early psychosocial development. c. substance abuse history and current use.

ANS: A, B, C, E Early psychosocial developmental history is less relevant to successful outcomes in the community than the assessments listed in the other options. If a client is homeless or fears homelessness, focusing on other treatment issues is impossible. Sufficient income for basic needs and medication is necessary. Adequate support is a requisite to community placement. Substance abuse undermines medication effectiveness and interferes with community adjustment.

A psychiatric nurse discusses rules of the therapeutic milieu and clients' rights with a newly admitted client. Which rights should be included? (Select all that apply.) a. The right to have visitors. b. The right to confidentiality. c. The right to a private room. d. The right to report inadequate care. e. The right to select the nurse assigned to their care.

ANS: A, B, D Clients' rights should be discussed shortly after admission. Clients have rights related to receiving/refusing visitors, privacy, filing complaints about inadequate care, and accepting/refusing treatments (including medications). Clients do not have a right to a private room or selecting which nurse will provide care.

A client states, "I'm starting cognitive-behavioral therapy. What can I expect from the sessions?" Which responses by the nurse would be appropriate? (Select all that apply.) a. "The therapist will be active and questioning." b. "You will be given some homework assignments." c. "The therapist will ask you to describe your dreams." d. "The therapist will help you look at your ideas and beliefs about yourself." e. "The goal is to increase subjectivity about thoughts that govern your behavior."

ANS: A, B, D Cognitive therapists are active rather than passive during therapy sessions because they help client's reality-test their thinking. Homework assignments are given and completed outside the therapy sessions. Homework is usually discussed at the next therapy session. The goal of cognitive therapy is to assist the client in identifying inaccurate cognitions and in reality-testing and formulating new, accurate cognitions. One distracter applies to psychoanalysis. Increasing subjectivity is not desirable.

Which statements by clients diagnosed with a serious mental illness best demonstrate that the case manager has established an effective long-term relationship? (Select all that apply.) a. "My case manager talks in language I can understand." b. "My case manager helps me keep track of my medication." c. "My case manager gives me little gifts from time to time." d. "My case manager looks at me as a whole person with many needs." e. "My case manager let me do whatever I choose without interfering."

ANS: A, B, D Each correct answer is an example of appropriate nursing foci: communicating at a level understandable to the client, providing medication supervision, and using holistic principles to guide care. the distracters violate relationship boundaries or suggest a laissez faire attitude on the part of the nurse.

A person in the community asks, "People with mental illnesses went to state hospitals in earlier times. Why has that changed?" What are the accurate responses. (Select all that apply.) a. "Science has made significant improvements in drugs for mental illness, so now many persons may live in their communities." b. "There's now a better selection of less restrictive treatment options available in communities to care for people with mental illness." c. "National rates of mental illness have declined significantly. There actually is not a need for state institutions anymore." e. "Most psychiatric institutions were closed because of serious violations of clients' rights and unsafe conditions." d. "Federal legislation and payment for treatment of mental illness has shifted the focus to community rather than institutional settings."

ANS: A, B, E The community is a less restrictive alternative than hospitals for treatment of persons with mental illness. Funding for treatment of mental illness remains largely inadequate but now focuses on community rather than institutional care. Antipsychotic medications improve more symptoms of mental illness; hence, management of psychiatric disorders has improved. Rates of mental illness have increased, not decreased. Hospitals were closed because funding shifted to the community. Conditions in institutions have improved.

The health care team at an inpatient psychiatric facility drafts these criteria for admission. Which criteria should be included in the final version of the admission policy? (Select all that apply.) a. Clear risk of danger to self or others b. Adjustment needed for doses of psychotropic medication c. Detoxification from long-term heavy alcohol consumption needed d. Respite for caregivers of persons with serious and persistent mental illness e. Failure of community-based treatment, demonstrating need for intensive treatment

ANS: A, C, E Medication doses can be adjusted on an outpatient basis. the goal of caregiver respite can be accomplished without hospitalizing the client. the other options are acceptable, evidence-based criteria for admission of a client to an inpatient service.

A client diagnosed with schizophrenia lives in the community. On a home visit, the community psychiatric nurse case manager learns that the client: · wants to attend an activity group at the mental health outreach center. · is worried about being able to pay for the therapy. · does not know how to get from home to the outreach center. · has an appointment to have blood work at the same time an activity group meets. · wants to attend services at a church that is a half-mile from the client's home. Which tasks are part of the role of a community mental health nurse? (Select all that apply.) a. Rearranging conflicting care appointments b. Negotiating the cost of therapy for the client c. Arranging transportation to the outreach center d. Accompanying the client to church services weekly e. Monitoring to ensure the client's basic needs are met

ANS: A, C, E The correct answers reflect the coordinating role of the community psychiatric nurse case manager. Negotiating the cost of therapy and accompanying the client to church services are interventions the nurse would not be expected to undertake. the client can walk to the church services; the nurse can provide encouragement.

Which comments by an elderly person best indicate successful completion of the individual's psychosocial developmental task? (Select all that apply.) a. "I am proud of my children's successes in life." b. "I should have given to community charities more often." c. "My relationship with my father made life more difficult for me." d. "My experiences in the war helped me appreciate the meaning of life." e. " I often wonder what would have happened if I had chosen a different career."

ANS: A, D The developmental crisis for an elderly person relates to integrity versus despair. Pride in one's offspring indicates a sense of fulfillment. Recognition of the wisdom gained from difficult experiences (such as being in a war) indicates a sense of integrity. Blaming and regret indicate despair and unsuccessful resolution of the crisis.

Which findings are signs of a person who is mentally healthy? (Select all that apply.) a. Says, "I have some weaknesses, but I feel I'm important to my family and friends." b. Adheres strictly to religious beliefs of parents and family of origin. c. Spends all holidays alone watching old movies on television. d. Considers past experiences when deciding about the future. e. Experiences feelings of conflict related to changing jobs.

ANS: A, D, E Mental health is a state of well-being in which each individual is able to realize his or her own potential, cope with the normal stresses of life, work productively, and make a contribution to the community. Mental health provides people with the capacity for rational thinking, communication skills, learning, emotional growth, resilience, and self-esteem.

Which comments by an adult best indicate self-actualization? (Select all that apply.) a. "I am content with a good book." b. "I often wonder if I chose the right career." c. "Sometimes I think about how my parents would have handled problems." d. "It's important for our country to provide basic health care services for everyone." e. "When I was lost at sea for 2 days, I gained an understanding of what is important"

ANS: A, D, E Self-actualized persons enjoy privacy, have a sense of democracy, and show positive outcomes associated with peak experiences. Self-doubt, defensiveness, and blaming are not consistent with self-actualization.

The scope of practice for an advanced nurse practitioner would include which intervention? a. Conducting a mental health assessment. b. Prescribing psychotropic medication. c. Establishing a therapeutic relationship. d. Individualizing a nursing care plan.

ANS: B In most states, prescriptive privileges are granted to master's-prepared nurse practitioners and clinical nurse specialists who have taken special courses on prescribing medication. The nurse prepared at the basic level is permitted to perform mental health assessments, establish relationships, and provide individualized care planning.

Which characteristic would be more applicable to a community mental health nurse than to a nurse working in an operating room? a. Kindness b. Autonomy c. Compassion d. Professionalism

ANS: B A community mental health nurse often works autonomously. Kindness, compassion, and professionalism apply to both nurses.

Which statement by a client would lead the nurse to suspect unsuccessful completion of the psychosocial developmental task of infancy? a. "I know how to do things right, so I prefer jobs where I work alone rather than on a team." d. "I do not allow other people to truly get to know me." c. "I depend on frequent praise from others to feel good about myself." d. "I usually need to do things several times before I get them right."

ANS: B According to Erikson, the developmental task of infancy is the development of trust. The correct response is the only statement clearly showing lack of ability to trust others. An inability to work with others, coupled with a sense of superiority, suggests unsuccessful completion of the task of intimacy versus isolation. Relying on praise from others suggests unsuccessful completion of the task of identity versus role confusion. Shame suggests failure to resolve the crisis of initiative versus guilt.

Which level of prevention activities would a nurse in an emergency department employ most often? a. Primary b. Secondary c. Tertiary

ANS: B An emergency department nurse would generally see clients in crisis or with acute illness, so secondary prevention is used. Primary prevention involves preventing a health problem from developing, and tertiary prevention applies to rehabilitative activities.

The relationship of the North American Nursing Diagnosis Association (NANDA) is to clinical judgment as Nursing Interventions Classification (NIC) is to what? a. client outcomes. b. nursing actions. c. diagnosis. d. symptoms.

ANS: B Analogies show parallel relationships. NANDA, the North American Nursing Diagnosis Association, identifies diagnostic statements regarding human responses to actual or potential health problems. These statements represent clinical judgments. NIC (Nursing Interventions Classification) identifies actions provided by nurses that enhance client outcomes. Nursing care activities may be direct or indirect.

A client says, "All my life I've been surrounded by stupidity. Everything I buy breaks because the entire American workforce is incompetent." This client is experiencing what type of reaction? a. self-esteem deficit. b. cognitive distortion. c. deficit in motivation. d. deficit in love and belonging.

ANS: B Automatic thoughts, or cognitive distortions, are irrational and lead to false assumptions and misinterpretations. See related audience response question.

A client says, "I always feel good when I wear a size 2 petite." Which type of cognitive distortion is evident? a. Disqualifying the positive b. Overgeneralization d. Catastrophizing c. Personalization

ANS: B Automatic thoughts, or cognitive distortions, are irrational and lead to false assumptions and misinterpretations. The stem offers an example of overgeneralization. See related audience response question.

Which assessment finding for a client diagnosed with serious and persistent mental illness and living in the community merits priority intervention by the psychiatric nurse? a. The client receives social security disability income plus a small check from a trust fund every month. b. The client was absent from two of six planned Alcoholics Anonymous meetings in the past 2 weeks. c. The client lives in an apartment with two clients who attend partial hospitalization programs. d. The client has a sibling who was recently diagnosed with a mental illness.

ANS: B Clients who use alcohol or illegal substances often become medication non-adherent. Medication non-adherence, along with the disorganizing influence of substances on cellular brain function, promotes relapse. the distracters do not suggest problems.

A nurse receives these three phone calls regarding a newly admitted client. · The psychiatrist wants to complete an initial assessment. · An internist wants to perform a physical examination. · The client's attorney wants an appointment with the client. The nurse schedules the activities for the client. Which role has the nurse fulfilled? a. Advocate b. Case manager c. Milieu manager d. Provider of care

ANS: B Nurses on psychiatric units routinely coordinate client services, serving as case managers as described in this scenario. the role of advocate would require the nurse to speak out on the client's behalf. the role of milieu manager refers to maintaining a therapeutic environment.Provider of care refers to giving direct care to the client.

A nurse inspects an inpatient psychiatric unit and finds that exits are free of obstructions, no one is smoking, and the janitor's closet is locked. What do these observations relate to? a. coordinating care of clients. b. management of milieu safety. c. management of the interpersonal climate. d. use of therapeutic intervention strategies.

ANS: B Nursing staff are responsible for all aspects of milieu management. the observations mentioned in this question directly relate to the safety of the unit. the other options, although part of the nurse's concerns, are unrelated to the observations cited.

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

ANS: B Primary prevention activities are directed to healthy populations to provide information for developing skills that promote mental health. the distracters represent secondary or tertiary prevention activities.

What is an example of primary prevention? a. Assisting a person diagnosed with a serious mental illness to fill a pill-minder b. Helping school-age children identify and describe normal emotions c. Leading a psychoeducational group in a community care home d. Medicating an acutely ill client who assaulted a staff person

ANS: B Primary preventions are directed at healthy populations with a goal of preventing health problems from occurring. Helping school-age children describe normal emotions people experience promotes coping, a skill that is needed throughout life. Assisting a person with serious and persistent mental illness to fill a pill-minder is an example of tertiary prevention. Medicating an acutely ill client who assaulted a staff person is a secondary prevention. Leading a psychoeducational group in a community care home is an example of tertiary prevention.

A client is fearful of riding on elevators. The therapist first rides an escalator with the client. The therapist and client then stand in an elevator with the door open for 5 minutes and later with the elevator door closed for 5 minutes. Which technique has the therapist used? a. Classic psychoanalytic therapy b. Systematic desensitization c. Rational emotive therapy d. Biofeedback

ANS: B Systematic desensitization is a form of behavior modification therapy that involves the development of behavior tasks customized to the client's specific fears. These tasks are presented to the client while using learned relaxation techniques. The client is incrementally exposed to the fear.

A nurse wants to find a description of diagnostic criteria for anxiety disorders. Which resource would have the most complete information? a. Nursing Outcomes Classification (NOC) b. DSM-V c. The ANA‟s Psychiatric-Mental Health Nursing Scope and Standards of Practice d. ICD-10

ANS: B The DSM-V details the diagnostic criteria for psychiatric clinical conditions. It is the official guideline for diagnosing psychiatric disorders. The other references are good resources but do not define the diagnostic criteria.

Which assessment finding most clearly indicates that a client may be experiencing a mental illness? a. reporting occasional sleeplessness and anxiety. b. reporting a consistently sad, discouraged, and hopeless mood. c. being able to describe the difference between "as if" and "for real." d. experiencing difficulty making a decision about whether to change jobs.

ANS: B The correct response describes a mood alteration, which reflects mental illness. The distracters describe behaviors that are mentally healthy or within the usual scope of human experience.

Which component of treatment of mental illness is specifically recognized by Quality and Safety Education for Nurses (QSEN)? a. All genomes are unique. b. Care is centered on the client. c. Healthy development is vital to mental health. d. Recovery occurs on a continuum from illness to health.

ANS: B The key areas of care promoted by QSEN are client-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics.

A student nurse says, "I don't need to interact with my clients. I learn what I need to know by observation." An instructor can best interpret the nursing implications of Sullivan's theory to this student by providing what response? a. "Interactions are required in order to help you develop therapeutic communication skills." b. "Nurses cannot be isolated. We must interact to provide clients with opportunities to practice interpersonal skills." c. "Observing client interactions will help you formulate priority nursing diagnoses and appropriate interventions." d. "It is important to pay attention to clients' behavioral changes, because these signify adjustments in personality."

ANS: B The nurse's role includes educating clients and assisting them in developing effective interpersonal relationships. Mutuality, respect for the client, unconditional acceptance, and empathy are cornerstones of Sullivan's theory. The nurse who does not interact with the client cannot demonstrate these cornerstones. Observations provide only objective data. Priority nursing diagnoses usually cannot be accurately established without subjective data from the client. The other distracters relate to Maslow and behavioral theory. This item relates to an audience response question.

A nurse influenced by Peplau's interpersonal theory works with an anxious, withdrawn client. What principle will the interventions be focused on? a. Rewarding desired behaviors. b. Using assertive communication. c. Changing the client's self-concept. d. Administering medications to relieve anxiety.

ANS: B The nurse-client relationship is structured to provide a model for adaptive interpersonal relationships that can be generalized to others. Helping the client learn to use assertive communication will improve the client's interpersonal relationships. The distracters apply to theories of cognitive, behavioral, and biological therapy.

The parent of a child diagnosed with schizophrenia tearfully asks the nurse, "What could I have done differently to prevent this illness?" What is the nurse's best response? a. Although schizophrenia results from impaired family relationships, try not to feel guilty. No one can predict how a child will respond to parental guidance." b. "Schizophrenia is a biological illness resulting from changes in how the brain and nervous system function. You are not to blame for your child's illness." c. "There is still hope. Changing your parenting style can help your child learn to cope effectively with the environment." d. "Most mental illnesses result from genetic inheritance. Your genes are more at fault than your parenting."

ANS: B The parent's comment suggests feelings of guilt or inadequacy. The nurse's response should address these feelings as well as provide information. Clients and families need reassurance that the major mental disorders are biological in origin and are not the ―fault‖ of parents. One distracter places the burden of having faulty genes on the shoulders of the parents. The other distracters are neither wholly accurate nor reassuring.

A nursing student expresses concerns that mental health nurses "lose all their clinical nursing skills." Select the best response by the mental health nurse. a. "Psychiatric nurses practice in safer environments than other specialties. Nurse-to-client ratios must be better because of the nature of the clients' problems." b. "Psychiatric nurses use complex communication skills as well as critical thinking to solve multidimensional problems. I am challenged by those situations." c. "That's a misconception. Psychiatric nurses frequently use high technology monitoring equipment and manage complex intravenous therapies." d. "Psychiatric nurses do not have to deal with as much pain and suffering as medical-surgical nurses do. That appeals to me."

ANS: B The practice of psychiatric nursing requires a different set of skills than medical-surgical nursing, though there is substantial overlap. Psychiatric nurses must be able to help clients with medical as well as mental health problems, reflecting the holistic perspective these nurses must have. Nurse-client ratios and workloads in psychiatric settings have increased, just like other specialties. Psychiatric nursing involves clinical practice, not just documentation. Psychosocial pain and suffering are as real as physical pain and suffering.

A client participated in psychotherapy weekly for 5 months. The therapist used free association, dream analysis, and facilitated transference to help the client understand conflicts and foster change. What is the term that applies to this method? a. Rational-emotive behavior therapy b. Psychodynamic psychotherapy d. Cognitive-behavioral therapy c. Operant conditioning

ANS: B The techniques are aspects of psychodynamic psychotherapy. The distracters use other techniques.

A parent says, ―My 2-year-old child refuses toilet training and shouts "No!" when given directions. "What do you think is wrong?" What is the nurse's best reply? a. "Your child needs firmer control. It is important to set limits now." b. "This is normal for your child's age. The child is striving for independence." c. "There may be developmental problems. Most children are toilet trained by age 2." d. "Some undesirable attitudes are developing. A child psychologist can help you develop a plan."

ANS: B This behavior is conventional of a child around the age of 2 years, whose developmental task is to develop autonomy. The distracters indicate the child's behavior is abnormal.

After a Category 5 tornado hits a community and destroys many homes and businesses, a community mental health nurse encourages victims to describe their memories and feelings about the event. What does this action by the nurse best demonstrate? a. triage. b. primary prevention. c. psychosocial rehabilitation. d. psychiatric case management.

ANS: B Tornado victims are at risk for psychiatric problems as a consequence of stress and trauma. Primary prevention occurs before any problem is manifested and seeks to reduce the incidence, or rate of new cases. Primary prevention may prevent or delay the onset of symptoms in predisposed individuals. Coping strategies and psychosocial support for vulnerable people are effective interventions in prevention. Disaster victims benefit from telling their story. Triage refers to the process of sorting out victims based on the immediacy of their needs for treatment. Psychosocial rehabilitation programs are designed to assist persons diagnosed with serious mental illness to develop living skills. Psychiatric case management refers to services to assist clients in finding housing or obtaining entitlements.

A client says to the nurse, "My father has been dead for over 10 years but talking to you is almost as comforting as the talks he and I had when I was a child." Which term applies to the client's comment? a. Superego b. Transference c. Reality testing d. Countertransference

ANS: B Transference refers to feelings a client has toward the health care workers that were originally held toward significant others in his or her life. Countertransference refers to unconscious feelings that the health care worker has toward the client. The superego represents the moral component of personality; it seeks perfection.

Which activities represent the caring foundation of nursing? (Select all that apply.) a. Administering medications on time to a group of clients b. Listening to a new widow grieve her husband's death c. Helping a client obtain groceries from a food bank d. Teaching a client about a new medication e. Holding the hand of a frightened client

ANS: B, C, E Patricia Benner described caring as the foundation professional nursing practice. Benner encourages nurses to provide caring and comforting interventions. She emphasizes the importance of the nurse-client relationship and the importance of teaching and coaching the client and bearing witness to suffering as the client deals with illness.

A nurse is part of a multidisciplinary team working with groups of depressed clients. One group of clients receives supportive interventions and antidepressant medication. The other group receives only medication. The team measures outcomes for each group. Which type of study is evident? a. Incidence b. Prevalence c. Comorbidity d. Clinical epidemiology

ANS: D Clinical epidemiology is a broad field that addresses studies of the natural history (or what happens if there is no treatment and the problem is left to run its course) of an illness, studies of diagnostic screening tests, and observational and experimental studies of interventions used to treat people with the illness or symptoms. Prevalence refers to numbers of new cases. Comorbidity refers to having more than one mental disorder at a time. Incidence refers to the number of new cases of mental disorders in a healthy population within a given period. See related audience response question.

Clinical pathways are used in managed care settings to accomplish what? a. stabilization of aggressive clients. b. identifying obstacles to effective care. c. relieving nurses of planning responsibilities. d. streamlining the care process to reduce costs.

ANS: D Clinical pathways provide guidelines for assessments, interventions, treatments, and outcomes as well as a designated timeline for accomplishment. Deviations from the timeline must be reported and investigated. Clinical pathways streamline the care process and save money. Care pathways do not identify obstacles or stabilize aggressive clients. Staff are responsible for the necessary interventions. Care pathways do not relieve nurses of the responsibility of planning; pathways may, however, make the task easier.

A client expresses a desire to be cared for by others and often behaves in a helpless fashion. Which stage of psychosexual development is most relevant to the client's needs? a. Latency b. Phallic c. Anal d. Oral

ANS: D Fixation at the oral stage sometimes produces dependent infantile behaviors in adults. Latency fixations often result in difficulty identifying with others and developing social skills, resulting in a sense of inadequacy and inferiority. Phallic fixations result in having difficulty with authority figures and poor sexual identity. Anal fixation sometimes results in retentiveness, rigidity, messiness, destructiveness, and cruelty. This item relates to an audience response question.

A nurse listens to a group of recent retirees. One says, "I volunteer with Meals on Wheels, coach teen sports, and do church visitation." Another laughs and says, "I'm too busy taking care of myself to volunteer to help others." Which psychosocial developmental task do these statements contrast? a. Trust and mistrust b. Intimacy and isolation c. Industry and inferiority d. Generativity and self-absorption

ANS: D Both retirees are in middle adulthood, when the developmental crisis to be resolved is generativity versus self-absorption. One exemplifies generativity; the other embodies self- absorption. This developmental crisis would show a contrast between relating to others in a trusting fashion and being suspicious and lacking trust. Failure to negotiate this developmental crisis would result in a sense of inferiority or difficulty learning and working as opposed to the ability to work competently. Behaviors that would be contrasted would be emotional isolation and the ability to love and commit oneself.

A person says, "I was the only survivor in a small plane crash. Three business associates died. I got depressed and saw a counselor twice a week for 4 weeks. We talked about my feelings related to being a survivor, and I'm better now." Which type of therapy was used? a. Systematic desensitization b. Psychoanalysis c. Behavior modification d. Interpersonal psychotherapy

ANS: D Interpersonal psychotherapy returned the client to his former level of functioning by helping him come to terms with the loss of friends and guilt over being a survivor. Systematic desensitization is a type of therapy aimed at extinguishing a specific behavior, such as the fear of flying. Psychoanalysis would call for a long period of exploration of unconscious material. Behavior modification would focus on changing a behavior rather than helping the client understand what is going on in his life.

Which nursing intervention below is part of the scope of an advanced practice psychiatric/mental health nurse rather than a basic level registered nurse? a. Coordination of care b. Health teaching c. Milieu therapy d. Psychotherapy

ANS: D Psychotherapy is part of the scope of practice of an advanced practice nurse. The distracters are within a basic level registered nurse's scope of practice.

A client in the emergency department says, "Voices say someone is stalking me. They want to kill me because I developed a cure for cancer. I have a knife and will stab anyone who is a threat." Which aspects of the client's mental health have the greatest and most immediate concern to the nurse? (Select all that apply.) a. Happiness b. Appraisal of reality c. Control over behavior d. Effectiveness in work e. Healthy self-concept

ANS: B, C, E The aspects of mental health of greatest concern are the client's appraisal of and control over behavior. The appraisal of reality is inaccurate. There are auditory hallucinations, delusions of persecution, and delusions of grandeur. In addition, the client's control over behavior is tenuous, as evidenced by the plan to stab anyone who seems threatening. A healthy self-concept is lacking, as evidenced by the delusion of grandeur. Data are not present to suggest that the other aspects of mental health (happiness and effectiveness in work) are of immediate concern.

A psychotherapist works with an anxious, dependent client. Which strategy is most consistent with psychoanalytic psychotherapy? a. Identifying the client's strengths and assets b. Praising the client for describing feelings of isolation c. Focusing on feelings developed by the client toward the therapist d. Providing psychoeducation and emphasizing medication adherence

ANS: C Positive or negative feelings of the client toward the therapist indicate transference. Transference is a psychoanalytic concept that can be used to explore previously unresolved conflicts. The distracters relate to biological therapy and supportive psychotherapy. Use of psychoeducational materials is a common "homework" assignment used in cognitive therapy.

A client usually watches television all day, seldom going out in the community or socializing with others. the client says, "I don't know what to do with my free time." Which member of the treatment team would be most helpful to this client? a. Psychologist b. Social worker c. Recreational therapist d. Occupational therapist

ANS: C Recreational therapists help clients use leisure time to benefit their mental health. Occupational therapists assist with a broad range of skills, including those for employment. Psychologists conduct testing and provide other client services. Social workers focus on the client's support system.

A college student received an invitation to attend the wedding of a close friend who lives across the country. The student is afraid of flying. Which type of therapy would be most helpful for this client? a. Psychoanalysis b. Aversion therapy c. Systematic desensitization d. Short-term dynamic therapy

ANS: C Systematic desensitization is a type of therapy aimed at extinguishing a specific behavior, such as the fear of flying. Psychoanalysis and short-term dynamic therapy seek to uncover conflicts. Aversion therapy involves use of a noxious stimulus, punishment, and avoidance.

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

ANS: C The DSM-V gives the criteria used to diagnose each mental disorder. It is the official guideline for diagnosing psychiatric disorders. The distracters may not contain diagnostic criteria for a psychiatric illness.

What is the initial action of a case manager who plans to discuss the treatment plan with a client's family? a. Determine an appropriate location for the conference. b. Support the discussion with examples of the client's behavior. c. Obtain the client's permission for the exchange of information. d. Determine which family members should participate in the conference.

ANS: C The case manager must respect the client's right to privacy, which extends to discussions with family. Talking to family members is part of the case manager's role. Actions identified in the distracters occur after the client has given permission.

A client was hospitalized for 24 hours after a reaction to a psychotropic medication. While planning discharge, the case manager learned that the client received a notice of eviction immediately prior to admission. What is the case manager's most appropriate action? a. Postpone the client's discharge from the hospital. b. Contact the landlord who evicted the client to further discuss the situation. c. Arrange a temporary place for the client to stay until new housing can be arranged. d. Determine whether the adverse medication reaction was genuine because the client had nowhere to live.

ANS: C The case manager should intervene by arranging temporary shelter for the client until an apartment can be found. This activity is part of the coordination and delivery of services that falls under the case manager role. None of the other options is a viable alternative.

The unit secretary receives a phone call from the health insurer for a hospitalized client. The caller seeks information about the client's projected length of stay. How should the nurse instruct the unit secretary to handle the request? a. Obtain the information from the client's medical record and relay it to the caller. b. Inform the caller that all information about clients is confidential. c. Refer the request for information to the client's case manager. d. Refer the request to the health care provider.

ANS: C The case manager usually confers with insurers and provides the treatment team with information about available resources. the unit secretary should be mindful of client confidentiality and should neither confirm that the client is an inpatient nor disclose other information.

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

ANS: C The correct response demonstrates an understanding that mental illness is physical in origin. The physical origins of mental illness are aspects of the biological model. The incorrect responses assign the origins of mental illness to interpersonal relationships and traumatic events.

Which individual behavior demonstrates resilience? a. Repress stressors associated with a divorce. b. Continuing to grieve the death of a spouse for 5 years. c. Continuing to live in a shelter for 2 years after the home is destroyed by fire. d. Taking a temporary job to maintain financial stability after loss of a permanent job.

ANS: D Resilience is closely associated with the process of adapting and helps people facing tragedies, loss, trauma, and severe stress. It is the ability and capacity for people to secure the resources they need to support their well-being. Repression and protracted grief are unhealthy. Living in a shelter for 2 years shows a failure to move forward after a tragedy. See related audience response question.

A family has a long history of conflicted relationships among the members. Which family member's comment best reflects a mentally healthy perspective? a. "I've made mistakes but everyone else in this family has also." b. "I remember joy and mutual respect from our early years together." c. "I will make some changes in my behavior for the good of the family." d. "It's best for me to move away from my family. Things will never change."

ANS: C The correct response demonstrates the best evidence of a healthy recognition of the importance of relationships. Mental health includes rational thinking, communication skills, learning, emotional growth, resilience, and self-esteem. Recalling joy from earlier in life may be healthy, but the correct response shows a higher level of mental health. The other incorrect responses show blaming and avoidance.

An adult dies in a tragic accident. Afterward, the siblings plan a funeral service. Which statement by a sibling best indicates a sense of self-actualization? a. "Of all of us, I am the most experienced with planning these types of events." b. "Funerals are supposed to be conducted quietly, respectfully, and according to a social protocol." c. "This death was unfair, but I hope we can plan a service that everyone feels is a celebration of life." d. "This death was probably the consequence of years of selfish and inconsiderate behavior by our sibling."

ANS: C The correct response shows an accurate perception of reality as well as a focus on solving the problem in a way that involves others. These factors are characteristic of self-actualization. The incorrect responses demonstrate self-centeredness, rigidity, and blaming which are characteristic of a failure to achieve self-actualization.

The parent of a 4-year-old rewards and praises the child for helping a sibling, being polite, and using good manners. These qualities are likely to be internalized and become part of which system of the personality? a. Id b. Ego c. Superego d. Preconscious

ANS: C The superego contains the "shoulds," or moral standards internalized from interactions with significant others. Praise fosters internalization of desirable behaviors. The id is the center of basic instinctual drives, and the ego is the mediator. The ego is the problem-solving and reality- testing portion of the personality that negotiates solutions with the outside world. The preconscious is a level of awareness from which material can be retrieved easily with conscious effort. This item relates to an audience response question.

An adult says, "I never know the answers," and "My opinion does not count." Which psychosocial crisis was unsuccessfully resolved for this adult? a. Initiative versus guilt b. Trust versus mistrust d. Autonomy versus shame and doubt c. Generativity versus self-absorption

ANS: C These statements show severe self-doubt, indicating that the crisis of gaining control over the environment was not met successfully. Unsuccessful resolution of the crisis of initiative versus guilt results in feelings of guilt. Unsuccessful resolution of the crisis of trust versus mistrust results in poor interpersonal relationships and suspicion of others. Unsuccessful resolution of the crisis of generativity versus self-absorption results in self-absorption that limits the ability to grow as a person.

Which comment best indicates a client is self-actualized? a. "I have succeeded despite a world filled with evil." b. "I have a plan for my life. If I follow it, everything will be fine." c. "I'm successful because I work hard. No one has ever given me anything." d. "My favorite leisure is walking on the beach, hearing soft sounds of rolling waves."

ANS: D The self-actualized personality is associated with high productivity and enjoyment of life. Self- actualized persons experience pleasure in being alone and an ability to reflect on events.

Which statements most clearly reflect the stigma of mental illness? (Select all that apply.) a. "Many mental illnesses are hereditary." b. "Mental illness can be evidence of a brain disorder." c. "People claim mental illness so they can get disability checks." d. "Mental illness results from the breakdown of American families." e. "If people with mental illness went to church, their symptoms would disappear."

ANS: C, D, E Stigma is represented by judgmental remarks that discount the reality and validity of mental illness. Many mental illnesses are genetically transmitted. Neuroimaging can show changes associated with some mental illnesses.

Which client would be most appropriate to refer for assertive community treatment (ACT)? a. One diagnosed with a phobic fear of crowded places. b. One who experienced a single episode of major depressive disorder. c. One who experienced a catastrophic reaction to a tornado in the community. d. One diagnosed with schizophrenia who had four hospitalizations in the past year.

ANS: D ACT provides intensive case management for persons with serious persistent mental illness who live in the community. Repeated hospitalization is a frequent reason for this intervention. the distracters identify mental health problems of a more episodic nature.

The psychiatric unit has one bed available. Which client should be admitted from the emergency department? a. The client feeling anxiety and a sad mood after separation from a spouse of 10 years. b. The client who self-inflicted a superficial cut on the forearm after a family argument. c. The client experiencing dry mouth and tremor related to taking antipsychotic medication. d. The client who is a new parent and hears voices saying, "Smother your baby."

ANS: D Admission to the hospital would be justified by the risk of client danger to self or others. the other clients have issues that can be handled with less restrictive alternatives than hospitalization.

How would the nurse assigned to ACT best explain the program's treatment goal? a. assisting clients to maintain abstinence from alcohol and other substances of abuse. b. providing structure and a therapeutic milieu for mentally ill clients whose symptoms require stabilization. c. maintaining medications and stable psychiatric status for incarcerated inmates who have a history of mental illness. d. providing services for mentally ill individuals who require intensive treatment to continue to live in the community.

ANS: D An ACT program provides intensive community services to persons with serious, persistent mental illness who live in the community but require aggressive services to prevent repeated hospitalizations.

Which aspect of direct care is an experienced, inpatient psychiatric nurse most likely to provide for a client? a. Hygiene assistance b. Diversional activities c. Assistance with job hunting d. Building assertiveness skills

ANS: D Assertiveness training relies on the counseling and psychoeducational skills of the nurse. Assistance with personal hygiene would usually be accomplished by a psychiatric technician or nursing assistant. Diversional activities are usually the province of recreational therapists. the client would probably be assisted in job hunting by a social worker or vocational therapist.

The nurse should refer which of the following clients to a partial hospitalization program? a. One who has a therapeutic lithium level and reports regularly for blood tests and clinic follow-up. b. One who needs psychoeducation for relaxation therapy related to agoraphobia and panic episodes. c. One who spent yesterday in a supervised crisis care center and continues to have active suicidal ideation. d. One who cannot avoid using alcohol when their spouse goes to work every morning

ANS: D This client could profit from the structure and supervision provided by spending the day at the partial hospitalization program. During the evening, at night, and on weekends, the spouse could assume responsibility for supervision. A suicidal client needs inpatient hospitalization. the other clients can be served in the community or with individual visits

Which therapies involve electrical brain stimulation for treatment of mental illness? (Select all that apply.) a. Aversion therapy b. Operant conditioning c. Systematic desensitization d. Electroconvulsive therapy (ECT) e. Transcranial magnetic stimulation (TMS)

ANS: D, E ECT and TMS are therapies that use electrical stimulation of the brain as a form of treatment for mental illness. The incorrect responses are therapies that are interpersonal in nature.

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

ANS: E The adult is generally happy and has an adequate self-concept. The statement indicates the adult is reality-oriented, works effectively, and has control over own behavior. Mental health does not mean that a person is always happy.

When a new bill introduced in Congress reduces funding for care of persons diagnosed with mental illness, a group of nurses write letters to their elected representatives in opposition to the legislation. Which role have the nurses fulfilled? a. Recovery b. Attending c. Advocacy d. Evidence-based practice

ANS: C An advocate defends or asserts another's cause, particularly when the other person lacks the ability to do that for self. Examples of individual advocacy include helping clients understand their rights or make decisions. On a community scale, advocacy includes political activity, public speaking, and publication in the interest of improving the human condition. Since funding is necessary to deliver quality programming for persons with mental illness, the letter-writing campaign advocates for that cause on behalf of clients who are unable to articulate their own needs.

A suspicious, socially isolated client lives alone, eats one meal a day at a local shelter, and spends the remaining daily food allowance on cigarettes. What is the community psychiatric nurse's best initial action? a. Exploring ways to help the client stop smoking. b. Reporting the situation to the manager of the shelter. c. Assessing the client's weight; determine foods and amounts eaten. d. Arranging hospitalization for the client in order to formulate a new treatment plan.

ANS: C Assessment of biopsychosocial needs and general ability to live in the community is called for before any other action is taken. Both nutritional status and income adequacy are critical assessment parameters. A client may be able to maintain adequate nutrition while eating only one meal a day. the rule is to assess before taking action. Hospitalization may not be necessary. Smoking cessation strategies can be pursued later.

A client diagnosed with schizophrenia had an exacerbation related to medication non-adherence and was hospitalized for 5 days. the client's thoughts are now more organized, and discharge is planned. the client's family says, "It's too soon for discharge. We will just go through all this again." What action should the nurse take? a. ask the case manager to arrange a transfer to a long-term care facility. b. notify hospital security to handle the disturbance and escort the family off the unit. c. explain that the client will continue to improve if the medication is taken regularly. d. contact the health care provider to meet with the family and explain the discharge rationale.

ANS: C Clients do not stay in a hospital until every symptom disappears. the nurse must assume responsibility to advocate for the client's right to the least restrictive setting as soon as the symptoms are under control and for the right of citizens to control health care costs. the health care provider will use the same rationale. Shifting blame will not change the discharge. Security is unnecessary. the nurse can handle this matter.

Which disorder is an example of a culture-bound syndrome? a. Epilepsy b. Schizophrenia c. Running amok d. Major depressive disorder

ANS: C Culture-bound syndromes occur in specific sociocultural contexts and are easily recognized by people in those cultures. A syndrome recognized in parts of Southeast Asia is running amok, in which a person (usually a male) runs around engaging in furious, almost indiscriminate violent behavior.

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

ANS: C Many of the most prevalent and disabling mental disorders have strong biological influences. Genetics are only one part of biological factors. Empathy does not address increasing the spouse's level of knowledge about the cause of the disorder. The other distracters are not established facts.

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

ANS: C Operant conditioning involves giving positive reinforcement for a desired behavior. Treats are rewards and reinforce speech through positive reinforcement.

Which belief will best support a nurse's efforts to provide client advocacy during a multidisciplinary client care planning session? a. All mental illnesses are culturally determined. b. Schizophrenia and bipolar disorder are cross-cultural disorders. c. Symptoms of mental disorders are unchanged from culture to culture. d. Assessment findings in mental illness reflect a person's cultural patterns.

ANS: D Symptoms must be understood in terms of a person's cultural background. A nurse who understands that a client's symptoms are influenced by culture will be able to advocate for the client to a greater degree than a nurse who believes that culture is of little relevance. The distracters are untrue statements.

A citizen at a community health fair asks the nurse, "What is the most prevalent mental disorder in the United States?" Select the nurse's correct response. a. Schizophrenia b. Bipolar disorder c. Dissociative fugue d. Alzheimer's disease

ANS: D The 12-month prevalence for Alzheimer's disease is 10% for persons older than 65% and 50% for persons older than 85. The prevalence of schizophrenia is 1.1% per year. The prevalence of bipolar disorder is 2.6%. Dissociative fugue is a rare disorder.

What does the DSM-V classify? a. deviant behaviors b. present disability or distress c. people with mental disorders d. mental disorders

ANS: D The DSM-V classifies disorders people have rather than people themselves. The terminology of the tool reflects this distinction by referring to individuals with a disorder rather than as a "schizophrenic" or "alcoholic," for example. Deviant behavior is not generally considered a mental disorder. Present disability or distress is only one aspect of the diagnosis.

A nurse wants to find information on current evidence-based research, programs, and practices regarding mental illness and addictions. Which resource should the nurse consult? a. American Psychiatric Association b. American Psychological Association (APA) c. Clinician's Quick Guide to Interpersonal Psychotherapy d. Substance Abuse and Mental Health Services Administration (SAMHSA)

ANS: D The SAMHSA maintains a National Registry of Evidence-based Practices and Programs. New therapies are entered into the database on a regular basis. The incorrect responses are resources but do not focus on evidence-based information.

A health care provider prescribed long acting antipsychotic medication injections every 3 weeks at the clinic for a client with a history of medication non adherence. For this plan to be successful, which factor will be of critical importance? a. The attitude of significant others toward the client b. Nutrition services in the client's neighborhood c. The level of trust between the client and nurse d. The availability of transportation to the clinic

ANS: D The ability of the client to get to the clinic is of paramount importance to the success of the plan. the long acting antipsychotic medication injections relieve the client of the necessity to take medication daily, but if he or she does not receive the injection at 3-week intervals, non- adherence will again be the issue. Attitude toward the client, trusting relationships, and nutrition are important but not fundamental to this particular problem.

A 26-month-old displays negative behavior, refuses toilet training, and often says, "No!" Which psychosocial crisis is evident? a. Trust versus mistrust b. Initiative versus guilt c. Industry versus inferiority d. Autonomy versus shame and doubt

ANS: D The crisis of autonomy versus shame and doubt relates to the developmental task of gaining control of self and environment, as exemplified by toilet training. This psychosocial crisis occurs during the period of early childhood. Trust versus mistrust is the crisis of the infant. Initiative versus guilt is the crisis of the preschool and early-school-aged child. Industry versus inferiority is the crisis of the 6- to 12-year-old child.

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

ANS: D The individual will be living up to the ego ideal, which will result in positive feelings about self. The other options are incorrect because each represents a negative feeling.

A client's relationships are intense and unstable. The client initially idealizes the significant other and then devalues him or her, resulting in frequent feelings of emptiness. This client will benefit from interventions to develop which aspect of mental health? a. Effectiveness in work b. Communication skills c. Productive activities d. Fulfilling relationships

ANS: D The information given centers on relationships with others that are described as intense and unstable. The relationships of mentally healthy individuals are stable, satisfying, and socially integrated. Data are not present to describe work effectiveness, communication skills, or activities.

What is the best response for the nurse to provide to a question from another health professional regarding the difference between a diagnosis in DSM-V and a nursing diagnosis. a. "There is no functional difference between the two. Both identify human disorders." b. "The DSM-V diagnosis disregards culture, whereas the nursing diagnosis takes culture into account." c. "The DSM-V diagnosis describes causes of disorders whereas a nursing diagnosis does not explore etiology." d. "The DSM-V diagnosis guides medical treatment, whereas the nursing diagnosis offers a framework for identifying interventions for issues a client is experiencing."

ANS: D The medical diagnosis is concerned with the client's disease state, causes, and cures, whereas the nursing diagnosis focuses on the client's response to stress and possible caring interventions. Both tools consider culture. The DSM-V is multiaxial. Nursing diagnoses also consider potential problems.