Quiz 1 Practice Questions
The nurse decides to tell the client of his terminal status because she believes it is her duty to do so. Which of the following ethical theories is considered in this decision? a. Natural law theories b. Ethical egoism c. Kantianism d. Utilitarianism
C
Three years ago, Anna's dog, Lucky, her pet for 16 years, was killed by a car. Since that time, Anna has lost weight, rarely leaves her home, and talks excessively about Lucky. Anna's behavior would be considered maladaptive for which of the following reasons? a. It has been more than 3 years since Lucky died. b. Her grief is too intense over the loss of a dog. c. Her grief is interfering with her functioning. d. Cultural norms typically do not comprehend grief over the loss of a pet.
C
Anna, who is 72 years old, is at the age when she may have experienced several losses in a short time. What is this called? a. Bereavement overload b. Normal mourning c. Isolation d. Cultural relativity
A
Which of the following hormones has been implicated in the etiology of mood disorder with seasonal affective disorder? a. Increased levels of melatonin b. Decreased levels of oxytocin c. Decreased levels of prolactin d. Increased levels of thyrotropin
A
Which of the following parts of the brain is associated with voluntary body movement, thinking and judgment, and expression of feeling? a. Frontal lobe b. Parietal lobe c. Temporal lobe d. Occipital lobe
A
. A client is being discharged from the inpatient psychiatric unit and states to his primary nurse, "Everyone abandons me and now you're probably going to abandon me, too." Which of these actions by the nurse best accomplishes termination of the therapeutic relationship? a. Discuss the boundaries of this relationship and assist the client to explore his feelings. b. Terminate the therapeutic relationship while exploring ways to remain connected as friends. c. Provide discharge medication instructions and encourage the client to follow up with his physician. d. Assure the client that he is not being abandoned and remind him that he can return to the unit in the future
A
. The nurse collects the following information during the admission assessment. For which of these pieces of data should the nurse take additional action to ensure that "duty to warn" laws are followed? a. The client threatens violence toward another individual. b. The client states he wants to kill everyone that has demons. c. The client is having command hallucinations. d. The client reveals paranoid delusions about another individual.
A
. Which of the following parts of the brain is concerned with hearing, short-term memory, and sense of smell? a. Temporal lobe b. Parietal lobe c. Cerebellum d. Hypothalamus
A
A client asks the nurse, "Do you think I should tell my husband about my affair with my boss?" Which is the most appropriate response by the nurse? a. "What do you think would be best for you to do?" b. "Of course you should. Marriage has to be based on truth." c. "Of course not. That would only make things worse." d. "I can't tell you what to do. You have to decide for yourself."
A
A client says to the nurse, "I've been offered a promotion, but I don't know if I can handle it." The nurse replies, "You're afraid you may fail in the new position." This is an example of which therapeutic technique? a. Restating b. Making observations c. Focusing d. Verbalizing the implied
A
A client states to the nurse, "I worked as a secretary to put my husband through college, and as soon as he graduated, he left me. I hate him! I hate all men!" Which of the following is an empathetic response by the nurse? a. "You are very angry now. This is a normal response to your loss." b. "I know what you mean. Men can be very insensitive." c. "I understand completely. My husband divorced me, too." d. "You are depressed now, but you will feel better in time."
A
A client who has arrived at the health clinic for diabetic education is perspiring, wringing his hands, and states, "I'm so anxious about giving myself shots I can hardly breathe. I don't know what to do." Which of these actions by the nurse demonstrates good clinical judgment? a. Assist the client in relaxation exercises before commencing diabetes education. b. Instruct the client that it is not hard to give oneself a shot and commence teaching. c. Assess the client further for symptoms of anxiety. d. Cancel diabetic education and encourage the client to reschedule when he feels less anxious.
A
A client with a history of violence is yelling in the dayroom and knocking over chairs. The nurse observes his increased agitation, clenched fists, and loud, demanding voice. He is challenging and threatening staff and the other clients. The nurse's priority intervention would be to: a. Call for assistance. b. Draw up a syringe of prn haloperidol. c. Ask the client if he would like to talk about his anger. d. Tell the client if he does not calm down, he will have to be restrained.
A
A depressed client who has been unkempt and untidy for weeks comes to group therapy today wearing makeup and a clean dress with hair washed and combed. Which of the following responses by the nurse is most appropriate? a. "I see you have put on a clean dress and combed your hair." b. "You look wonderful today!" c. "I'm sure everyone will appreciate that you have cleaned up for the group today." d. "Now that you see how important it is, I hope you will do this every day."
A
A spouse comes home from work and angrily shouts, "Why the heck isn't dinner ready?" Which of the following is an example of a passive-aggressive response? a. "I'm sorry. I'll have it done in no time, honey." But then intentionally takes a long time to cook the meal. b. "I'm tired, too. Make your own dinner, you bum! I'm tired of being your slave!" c. "I haven't started dinner yet. I'd like some help from you." d. "I'm so sorry. I know you're tired and hungry. It's all my fault!"
A
A teenager tells the high school nurse that her parents are drinking alcohol every day and she doesn't know what to do. Her grades are starting to drop, and she complains of feeling anxious and overwhelmed. The most appropriate nursing action in response to the client's complaint would be to: a. Facilitate arrangements for her to start attending Alateen meetings. b. Help her identify the positive things in her life and recognize that her situation could be a lot worse than it is. c. Teach her about the effects of alcohol on the body and that it can be hereditary. d. Refer her to a psychiatrist for private therapy to learn to cope with her home situation.
A
During a client education group on assertiveness skills, a client asks a question while some other group members are carrying on a separate conversation, appearing not to listen. The client states, "When you appear not to be listening, I feel disrespected. I need for the group to listen to my question." How should the nurse respond to this event? a. Reinforce that the client used assertive communication to express their needs and support that respect for other group members includes not having private conversations during the group. b. Tell the client to ask the question again and speak louder. c. Instruct the client that no one is being disrespectful but their low self-esteem may be influencing their perception. d. Terminate the group and offer to talk with the client privately about their questions.
A
The nurse decides to respect family wishes and not tell the client of his terminal status because that would bring the most happiness to the most people. Which of the following ethical theories is considered in this decision? a. Utilitarianism b. Kantianism c. Christian ethics d. Ethical egoism
A
Which of these actions by the nurse demonstrates an application of the QSEN competency related to informatics? a. Learns how to effectively communicate information using electronic health records b. Provides a verbal report of client behavioral issues at shift change c. Asks the supervisor for guidelines on how to prevent lawsuits d. Reads journals to learn information about new treatments and approaches to nursing care
A
You and your best friend, Jill, have had plans for 6 months to go on vacation together to Hawaii. You have saved your money and have plane tickets to leave in 3 weeks. She has just called you and reported that she is not going. She has a new boyfriend, they are moving in together, and she does not want to leave him. You are very angry with Jill for changing your plans. Which of the following is an example of an assertive response? a. "I'm very disappointed and very angry. I'd like to talk to you about this later. I'll call you." b. "I'm very happy for you, Jill. I think it's wonderful that you and Jack are moving in together." c. You tell Jill that you are very happy for her, but then say to another friend, "Well, that's the end of my friendship with Jill!" d. "What? You can't do that to me! We've had plans! You're acting like a real slut!"
A
You are having company for dinner, and they are due to arrive in 20 minutes. You are about to finish cooking and still have to shower and dress. The doorbell rings, and it is a man selling a new product for cleaning windows. Which of the following is an example of an aggressive response? a. "I don't do windows!" and slam the door in his face. b. "I'll take a case," and write him a check. c. "Sure, I'll take three bottles." Then to yourself you think: "I'm calling this company tomorrow and complaining to the manager about their salespeople coming around at dinnertime!" d. "I'm very busy at the moment. I don't wish to purchase any of your product. Thank you."
A
. Psychotropic medications may act at the neural synapse to accomplish which of the following? (Select all that apply.) a. Inhibit the reuptake of certain neurotransmitters, creating more availability b. Inhibit catabolic enzymes, promoting more availability of a neurotransmitter c. Block receptors, resulting in less neurotransmitter activity d. Add synthetic neurotransmitters found in the drug
A, B, C
3.WHICH BEHAVIORS SUGGEST A POSSIBLE BREACH OF PROFESSIONAL BOUNDARIES? (SELECT ALL THAT APPLY) a. Nurse repeatedly requests to be assigned to specific client b. Nurse shares details of her divorce c. Nurse makes arrangements to meet client outside hospital d. Nurse shares how she dealt with similar difficult situation
A, B, C
Which of the following behaviors suggest a possible breach of professional boundaries? (Select all that apply.) a. The nurse repeatedly requests to be assigned to a specific patient. b. The nurse shares the details of her divorce with the patient. c. The nurse makes arrangements to meet the patient outside of the therapeutic environment. d. The nurse shares how she dealt with a similar difficult situation.
A, B, C
Which of these procedures is important immediately following an episode of violence on the unit? (Select all that apply.) a. Document all observations and occurrences. b. Conduct a debriefing with the staff. c. Discuss what occurred with other clients who witnessed the incident. d. Warn the client that it could happen again if he becomes violent.
A, B, C
. A client with a history of violence has been hospitalized on the psychiatric unit. He becomes agitated and begins to threaten the staff and other clients. When all other interventions fail, the client is placed in restraints in the seclusion room for his and others' protection. Which of the following are interventions for the client in restraints? (Select all that apply.) a. Check temperature and pulse of extremities. b. Document all observations. c. Explain to the client that restraint is his punishment for violent behavior. d. Provide ongoing assessment and observation. e. Withhold food and fluids until the client is calm and can be released from restraints.
A, B, D
The environment in which communication takes place influences the outcome of the interaction. Which of the following are aspects of the environment that influence communication? (Select all that apply.) a. Territoriality b. Density c. Dimension d. Distance e. Intensity
A, B, D
Which of the following events would likely precipitate a crisis? (Select all that apply) a. First-time parenthood when the parents perceive they have inadequate support and education. b. Receiving a pay raise when the worker perceived they had to work very hard to accomplish their financial goals. c. A natural disaster such as a forest fire in which lives and property were lost. d. A peer or family member dies by suicide.
A, C, D
. A fourth-grade boy teases and makes jokes about a cute girl in his class. This behavior should be identified by a nurse as indicative of which defense mechanism? A. Displacement B. Projection C. Reaction formation D. Sublimation
ANS: C The nurse should identify that the boy is using reaction formation as a defense mechanism. Reaction formation is the attempt to prevent undesirable thoughts from being expressed by expressing opposite thoughts or behaviors. Displacement refers to transferring feelings from one target to another. Rationalization refers to making excuses to justify behavior. Projection refers to the attribution of unacceptable feelings or behaviors to another person. Sublimation refers to channeling unacceptable drives or impulses into more constructive, acceptable activities.
5. An employee uses the defense mechanism of displacement when the boss openly disagrees with suggestions. What behavior would be expected from this employee? A. The employee assertively confronts the boss B. The employee leaves the staff meeting to work out in the gym C. The employee criticizes a coworker D. The employee takes the boss out to lunch
ANS: C• The client using the defense mechanism of displacement would criticize a coworker after being confronted by the boss. Displacement refers to transferring feelings from one target to a neutral or less-threatening target.
. The nurse decides to go against family wishes and tell the client of his terminal status because that is what she would want if she were the client. Which of the following ethical theories is considered in this decision? a. Kantianism b. Christian ethics c. Natural law theories d. Ethical egoism
B
A client is admitted to the inpatient psychiatric unit after a suicide attempt. He reports that he has a history of depression but he became acutely suicidal after he recently lost his job. Which of these nursing actions is a priority in response to this client's psychiatric crisis? a. Assess why the client lost his job. b. Ensure that the client remains safe and free from further self-injury. c. Explore career interests and other job opportunities. d. Assess for substance use disorder.
B
A client is noted to be pacing with clenched fists and saying, "I'm not putting up with this anymore. They've been trying to trick me all along." Which of these actions by the nurse is most appropriate at this point? a. Gently touch the client's shoulder and reassure him that no one is trying to trick him. b. Ask the client to describe what's upsetting him. c. Offer the client medication. d. Don't intervene but continue to watch the client from a distance.
B
A client on the psychiatric unit begins yelling out loud that no one is listening to him and that he is going to "blow up" soon. The orderly asks the nurse if he should go ahead and put the client in restraints for the safety of others. Which of these responses by the nurse is most appropriate? a. Educate the orderly that restraints may never be initiated without a physician's order. b. Instruct the orderly that it would be best to see if the client can be assisted to calm down by listening to his concerns. c. Instruct the orderly to put the client in restraints but make sure to assess the client every 15 minutes for issues regarding circulation, nutrition, respiration, hydration, and elimination. d. Instruct the orderly to get others to assist him in restraining the client but be aware restraints should be discontinued at the earliest possible time regardless of when a physician's order is scheduled to expire.
B
A client states, "I refuse to shower in this room. I must be very cautious. The FBI has placed a camera in here to monitor my every move." Which of the following is the most therapeutic response? a. "That's not true." b. "I have a hard time believing that is true." c. "Surely you don't really believe that." d. "I will help you search this room so that you can see there is no camera."
B
A client who was admitted to the psychiatric unit for major depressive disorder reports to the nurse, "Ever since my daughter died by suicide 10 years ago, I can't stand to be around my friends. They just don't get it!" Which of these actions by the nurse demonstrates good clinical judgment? a. Affirm that other people cannot possibly provide adequate support in circumstances like these. b. Assist the client to explore the connection between grief and anger. c. Tell the client that her friends are doing the best they can and she should try to accept their support. d. Ask the client to describe how her daughter killed herself.
B
A client whose home was destroyed during a tornado expresses to the nurse that she is has been having disabling anxiety and nightmares for the last 2 weeks following this disaster. The most appropriate crisis intervention would be to: a. Encourage her to recognize how lucky she is to be alive. b. Discuss stages of grief and feelings associated with each. c. Identify community resources that can help Amanda. d. Suggest that she find a place to live that provides a storm shelter.
B
A client with a history of schizophrenia is brought to the emergency department by police who report that she was knocking down food displays at a grocery store and yelling that the food is all poisoned. The client reports to the nurse the she has no idea why she was brought to the emergency department because "there is nothing wrong with me." Which of these actions by the nurse demonstrates good clinical judgment? a. Instruct the police officer that this client should be incarcerated because there is nothing that can be done in an emergency department. b. Document that the client is manifesting suspicious ideation and anosognosia. c. Ask the doctor to order gastric lavage because the client reports having been poisoned. d. Instruct the client that the food is not poisoned and there is something very wrong with her
B
A client with schizophrenia appears very watchful of others and tells the nurse, "There are infiltrators everywhere and I think they are trying to kill me." Which of these actions by the nurse would best promote development of trust with this client? a. Touch the client's shoulder and state, "I want you to feel safe here." b. State to the client, "I'm interested in hearing your thoughts. Would you like to talk more about this?" c. Ask the client, "Why would you think such a thing?" d. Tell the client, "It is an expectation that we will not talk about things that aren't real."
B
A college student, who is an only child and attending school 500 miles away from his parents, reports to the nurse practitioner at the student health center that he has been having difficulty making decisions and will not undertake anything new without first consulting his mother. He has recently started having anxiety attacks. Which nursing action is most appropriate in response to this client's maturational crisis? a. Suggest that he move to a college closer to home. b. Help him to explore unresolved dependency issues. c. Help him find someone in the college town from whom he could seek assistance rather than calling his mother regularly. d. Recommend that the college physician prescribe an antianxiety medication for him.
B
A decrease in which of the following neurotransmitters has been implicated in depression? a. Gamma-aminobutyric acid, acetylcholine, and aspartate b. Norepinephrine, serotonin, and dopamine c. Somatostatin, substance P, and glycine d. Glutamate, histamine, and opioid peptides
B
A nurse decides to put a client who has a psychotic disorder in seclusion overnight because the unit is very short-staffed, and the client frequently fights with other clients. The nurse's actions are an example of which of the following torts? A. Invasion of Privacy B. False Imprisonment C. Assault D. Battery
B
A nurse hears a newly licensed nurse discussing a client's hallucinations in the hallway with another nurse. Which of the following actions should the nurse take first? A. Notify the nurse manager B. Tell the nurse to stop discussing the behavior C. Provide an in-service program about the behavior D. Complete an incident report
B
A physician approaches the nurse, yelling loudly and stating, "You must be the stupidest person to ever get out of nursing school. I said I wanted vital signs on this client every 4 hours and there are no recordings of temperatures. Do I need to teach you what vital signs are?" Which of these is the best response by the nurse? a. "Yes, doctor, I know what vital signs are." b. "I will try to find the information you are looking for, but I don't appreciate your belittling comments. I need for you to treat me with respect." c. "If you weren't so stupid you would know that the temperatures are recorded on a separate graph in the electronic health record." d. "I'm not doing a thing for you until you treat me with respect."
B
An adolescent who has just returned from group therapy is crying. She says to the nurse, "All the other kids laughed at me! I try to fit in, but I always seem to say the wrong thing. I've never had a close friend. I guess I never will." Which is the most appropriate response by the nurse? a. "What makes you think you will never have any friends?" b. "You're feeling pretty down on yourself right now." c. "I'm sure they didn't mean to hurt your feelings." d. "Why do you feel this way about yourself?"
B
Anna has been grieving the death of Lucky for 3 years. She is unable to take care of her normal activities because she insists on visiting Lucky's grave daily. What is the most likely reason that Anna's daughter has put off seeking help for Anna? a. Women are less likely than men to seek help for emotional problems. b. Relatives often try to normalize behavior rather than label it mental illness. c. She knows that all older people are expected to be a little depressed. d. She is afraid that the neighbors will think her mother is "crazy."
B
Anna's daughter notices that Anna appears to be listening to another voice when just the two of them are in a room together. When questioned, Anna admits that she hears someone telling her that she was a horrible caretaker for Lucky and did not deserve to ever have a pet. Which of the following best describes what Anna is experiencing? a. Neurosis b. Psychosis c. Depression d. Bereavement
B
The nurse assists the physician with electroconvulsive therapy on a client who has refused to give consent. With which of the following legal actions might the nurse be charged because of this nursing action? a. Assault b. Battery c. False imprisonment d. Breach of confidentiality
B
The nurse says to a client, "You are being readmitted to the hospital. Why did you stop taking your medication?" What communication technique does this represent? a. Disapproving b. Requesting an explanation c. Disagreeing d. Probing
B
The nurse, who is an adult child of an alcoholic, is working with a client who abuses alcohol. The client has experienced a successful detoxification process and is beginning a rehabilitation program. He says to the nurse, "I'm not going to go to those stupid AA meetings. They don't help anything." The nurse, whose father died of complications from alcoholism, responds with anger: "Don't you even care what happens to your children?" The nurse's response is an example of which of the following? a. Transference b. Countertransference c. Self-disclosure d. A breach of professional boundaries
B
When the nurse shows unconditional acceptance of an individual as a worthwhile and unique human being, he or she is exhibiting which of the following characteristics? a. Trust b. Respect c. Genuineness d. Empathy
B
Which of the following parts of the brain integrates all sensory input (except smell) on the way to the cortex? a. Temporal lobe b. Thalamus c. Limbic system d. Hypothalamus
B
You are in a movie theater that prohibits smoking. The person in the seat next to you just lit a cigarette, and the smoke is very irritating. Which of the following is an example of an assertive response? a. You say nothing. b. "Please put your cigarette out. Smoking is prohibited." c. You say nothing but begin to frantically fan the air in front of you and cough loudly and convulsively. d. "Put your cigarette out, you slob! Can't you read the 'no smoking' sign?"
B
. A client, age 27, was brought to the emergency department by two police officers. He smelled strongly of alcohol and was combative. His blood alcohol level was measured at 293 mg/dL. His girlfriend reported that he drinks excessively every day and is verbally and physically abusive. The nurse assigns the nursing diagnosis of "risk for other-directed violence." What would be appropriate outcome objectives for this diagnosis? (Select all that apply.) a. The client will not verbalize anger or hit anyone. b. The client will verbalize anger rather than hit others. c. The client will not harm self or others. d. The client will be restrained if he becomes verbally or physically abusive
B, C
A nurse is caring for a client who is in mechanical restraints. Which of the following should the nurse include in the documentation? (Select all that apply) A. Client ate most of their breakfast B. Client was offered 8oz of water every hour C. Client shouted obscenities at assistive personnel D. Client received chlorpromazine 15mg PO at 1000 E. Client acted out after lunch
B, C, D
Psychoneuroimmunology is a branch of science that involves which of the following? (Select all that apply.) a. The impact of psychoactive medications at the neural synapse b. The relationships between the immune system, the nervous system, and psychological processes including mental illness c. The correlation between psychosocial stress and the onset of illness d. The potential role of viruses in the onset of schizophrenia e. The genetic factors that influence the prevention of mental illness
B, C, D
Which of the following assessment data would the nurse consider as risk factors for possible violence in a client? (Select all that apply.) a. A diagnosis of somatization disorder b. A diagnosis of schizophrenia or bipolar disorder c. Substance intoxication d. Argumentative and demanding behavior e. Past history of violence
B, C, D, E
. Which of the following tasks are associated with the orientation phase of relationship development? (Select all that apply.) a. Promoting the patient's insight and perception of reality b. Creating an environment for the establishment of trust and rapport c. Using the problem-solving model toward goal fulfillment d. Obtaining available information about the patient from various sources e. Formulating nursing diagnoses and setting goals
B, E
. A client on the psychiatric unit approaches the nurse, strokes the nurse's arm, and says, "Why don't you be a sweetie and get me some pain medication." Which of these actions by the nurse demonstrates the best clinical judgment? a. Ignore the client's behavior and assess pain level. b. Inform the client that patronizing attitudes are not the best way to get more pain medication. c. Tell the client that this behavior is not appropriate and clarify unit rules and policies regarding touching others. d. Tell the client, "If you call me sweetie or touch me one more time I will call security and have you restrained."
C
. A client, who has been in the hospital for 3 weeks, has used Valium "to settle her nerves" for the past 15 years. She was admitted by her psychiatrist for safe withdrawal from the drug. She has passed the physical symptoms of withdrawal at this time but states to the nurse, "I don't know if I will be able to make it without Valium after I go home. I'm already starting to feel nervous. I have so many personal problems." Which is the most appropriate response by the nurse? a. "Why do you think you need drugs to deal with your problems?" b. "Everybody has problems, but not everybody uses drugs to deal with them. You'll just have to do the best that you can." c. "Let's explore some things you can do to decrease your anxiety without resorting to drugs." d. "Just hang in there. I'm sure everything is going to be okay."
C
. The client, a firefighter who responded to an industrial explosion, lost a coworker and close friend when they entered a building that collapsed. The client reports that since this event, he has had frequent nightmares and anxiety attacks. He says to the mental health worker, "I should have died, but instead I lost my best friend!" This statement suggests that the client is experiencing: a. Spiritual distress. b. Night terrors. c. Survivor's guilt. d. Suicidal ideation
C
. Which of the following is a desired outcome of working with an individual who has witnessed a traumatic event and is now experiencing panic anxiety? a. The individual will experience no anxiety. b. The individual will demonstrate hope for the future. c. The individual will identify that anxiety is at a manageable level. d. The individual will verbalize the acceptance of self as worthy.
C
. Which of the following parts of the brain deals with sensory perception and interpretation? a. Hypothalamus b. Cerebellum c. Parietal lobe d. Hippocampus
C
. Your spouse says, "You're crazy to think about going to college! You're not smart enough to handle the studies along with everything else." Which of the following is an example of a nonassertive response? a. "I will do what I can and the best that I can." b. (Thinking to yourself): "I'll just go anyway and keep it a secret." c. "You're probably right. Maybe I should reconsider." d. "I'm going to do what I want to do, when I want to do it, and you can't stop me!"
C
A client is brought to the emergency department by her college roommate and appears to be emotionless. The client reports that she was raped at a party earlier that evening. Which of these actions by the nurse is a priority? a. Ask the client if she would like to shower before she is examined. b. Confront the client about her apparent lack of emotion and ask if this was consensual sex. c. Affirm the client for seeking help and ask her to describe what happened. d. Ask the roommate if the client is typically so emotionless.
C
A client tells a nurse, "Don't tell anyone, but I hid a sharp knife under my mattress in order to protect myself from my roommate, who is always threatening me." Which action should the nurse take? A. Keep the client's communication confidential, but use therapeutic communication to convince them to admit to the knife B. Keep the client's communication confidential, but watch them closely C. Tell the client that they must be reported to the healthcare team D. Report to the healthcare team, but do not tell the client
C
A client who is being discharged from an inpatient hospital stay has his wife bring a box of chocolates and a bouquet of flowers for his primary nurse. He presents these gifts to the nurse, saying, "Thank you for taking care of me." What is the most appropriate response by the nurse? a. "I don't accept gifts from patients." b. "Thank you so much! It is so nice to be appreciated." c. "Thank you. I will share these with the rest of the staff." d. "Hospital policy forbids me to accept gifts from patients."
C
A client who was hospitalized with alcohol intoxication and violent behavior is sitting in the dayroom watching TV with the other clients when the nurse approaches with his 5 p.m. dose of haloperidol. The client says, "I feel in control now. I don't need any drugs." Which of these responses by the nurse demonstrates the best clinical judgment? a. Instruct him that he must take the medication because of his history of violence. b. Instruct him that if he will not take the medication orally, he will be restrained and given an intramuscular injection. c. Accept the client's refusal and document assessment of the client's mood and behavior. d. Secretly crush the medication into a beverage and offer it to the client.
C
A competent, voluntary client has stated he wants to leave the hospital. The nurse hides his clothes to keep him from leaving. With which of the following legal actions might the nurse be charged because of this nursing action? a. Assault b. Battery c. False imprisonment d. Breach of confidentiality
C
A nurse in an emergency mental health facility is caring for a group of clients. The nurse should identify that which of the following clients requires a temporary emergency admission? A. A client who has schizophrenia with delusions of grandeur B. A client who has manifestations of depression and attempted suicide a year ago C. A client who has borderline personality disorder and assaulted a homeless man with a metal rod D. A client who has bipolar disorder and paces quickly around the room while talking themselves
C
At a synapse, the determination of further impulse transmission is accomplished by means of which of the following? a. Potassium ions b. Interneurons c. Neurotransmitters d. The myelin sheath
C
During a primary care physician appointment, a client who has been a widow for 7 years reports to the nurse that she does not want to wake up in the morning and feels there is nothing left for her. Which of these actions by the nurse is a priority? a. Listen empathically and encourage the client to find some activities to increase socialization. b. Encourage the client to discuss this with her physician. c. Assess the client for symptoms of depression and suicide risk. d. Instruct the client that grief takes a long time to resolve but that she will be feeling better soon.
C
When it has been assessed that a client is in control and no longer requires restraint, what should the nurse do next? a. Remove the restraints. b. Medicate the client before removing restraints. c. With assistance, remove one restraint and assess the client's level of self-control. d. Tell the client he will have to wait until the doctor comes in.
C
When there is congruence between what is felt and what is expressed, the nurse is exhibiting which of the following characteristics? a. Trust b. Respect c. Genuineness d. Empathy
C
Which of the following is a correct assumption regarding the concept of crisis? a. Crises occur only in individuals with psychopathology. b. The stressful event that precipitates crisis is seldom identifiable. c. A crisis situation contains the potential for psychological growth or deterioration. d. Crises are chronic situations that recur many times during an individual's life.
C
AFTER REPEATED REQUESTS FOR A CLIENT TO UNPACK AND GET SETTLED ON THE PSYCHIATRIC UNIT, THE CLIENT STATES, "I HAVE NO INTENTION OF UNPACKING AND STAYING ON THIS UNIT." TO AVOID A CONFRONTATION, THE NURSE UNPACKS THE CLIENT'S BELONGINGS. WHICH NURSING BEHAVIOR IS EXEMPLIFIED? A. POSITIVE ROLE MODELING B. NEGATIVE OPERANT CONDITIONING C. ASSERTIVENESS D. AGGRESSIVENESS
CORRECT ANSWER: B• THIS SITUATION ILLUSTRATES NEGATIVE OPERANT CONDITIONING. THE CLIENT'S NEGATIVE BEHAVIOR HAS BEEN REINFORCED AND REWARDED BY THE NURSE'S ACTION OF UNPACKING FOR THE CLIENT.
A CLIENT HAS NOT RECEIVED WHAT WAS EXPECTED FOR LUNCH AND DIRECTS AN ANGRY VERBAL OUTBURST AT THE NURSE. WHICH IS AN ACCURATE DESCRIPTION OF THIS DISPLAY OF EMOTION? A. ANGER IS A PRIMARY EMOTION THAT IS AUTOMATICALLY EXPERIENCED. B. ANGER IS A PSYCHOLOGICAL AROUSAL. C. THE EXPRESSION OF ANGER CAN COME UNDER PERSONAL CONTROL. D. THE EXPRESSION OF ANGER AND AGGRESSION ARE CLOSELY RELATED
CORRECT ANSWER: C• THE EXPRESSION OF ANGER CAN COME UNDER PERSONAL CONTROL AND IS A LEARNED BEHAVIOR.
3. Which is a correct assumption related to concept of Crisis? A. Crisis occur only in individuals with psychopathology B. The stressful event that precipitates crisis is seldom identifiable. C. Crisis situations contain the potential for psychological growth or deterioration D. Crises are chronic situations that recur many times during an individual's life
Correct answer is C
2. For the past three days a student has skipped classes, cried constantly, experienced panic attacks, and is now exhibiting difficulty with short-term memory. In her assessment of this student, what crucial information should the nurse initially obtain prior to planning interventions? A. The student's description of the precipitating stressor B. The student's usual ability to cope with stress C. The student's available support system D. The student's access to community resources
Correct answer: A• It is important to assess the precipitating stressor that led to the student's behavioral symptoms. This data will be crucial when planning client care.
Which is the primary nursing goal when establishing a therapeutic relationship with a client? A. To promote client growth B. To develop the nurse's personal identity C. To establish a purposeful social interaction D. To develop communication skills
Correct answer: A• The goal of a therapeutic nursing interaction is to promote client insight and behavioral change directed toward client growth.
1. Two clients disagree on what movie to watch during free activity time. One client says to the other, "I would like to watch the comedy instead of the murder mystery." The nurse recognizes this as which form of communication response pattern? A. Nonassertive B. Assertive C. Aggressive D. Passive-Aggressive
Correct answer: B◦ Assertive individuals express feelings openly and honestly. Individuals using this communication pattern use "I" statements and communicate tactfully. The example presented in the question demonstrates the use of an assertive communication pattern.
1. Two students fail their introductory nursing course. One student plans to seek tutoring and retake the course next fall. The second student attempts suicide. Which of the following factors would have been influential in the development of the second student's crisis? A. The time of year in which the event occurred B. The presence of support systems C. A lack of adequate coping mechanisms D. The individual's family birth order
Correct answer: C• Adequate coping mechanisms can influence the development of a crisis. If a person can draw on past successful coping strategies, a crisis may be diverted. This student had a lack of adequate coping mechanisms.
1.A client hates her mother because of childhood neglect. The nurse determines which client statement represents the use of the defense mechanism of reaction formation? A. "I don't like to talk about my relationship with my mother." B."My mother hates me." C. "I have a very wonderful mother whom I love very much." D. "My mom always loved my sister more than she loved me."
Correct answer: C• The client hides her negative unacceptable feelings by the exaggerated expression of positive feelings. This is an example of the defense mechanism of reaction formation.
A client threatens to kill himself, his wife, and their children if the wife follows through with divorce proceedings. During the preinteraction phase of the nurse-patient relationship, which interaction should the nurse employ? A. Acknowledging the client's actions and encouraging alternative behaviors. B. Establishing rapport and developing treatment goals. C. Providing community resources on aggression management. D. Exploring personal thoughts and feelings that may adversely impact the provision of care.
Correct answer: D• In the preinteraction phase, the nurse must clarify personal attitudes, values, and beliefs to become aware of how these might affect the nurse's ability to care for various clients. This occurs before the nurse meets the client.
2. A nurse is conducting an assertiveness training class. Which of the following characteristics of assertive behavior should the nurse include? A. Eye contact should be steady and continuous. B. Invasion of intimate space can be interpreted as assertive behavior. C. While interacting, individuals should turn slightly away from the other person. D. The facial expression is congruent with the verbal message
Correct answer: D◦ Various facial expressions convey different messages. In assertive communication, the facial expression is congruent with the verbal message.
. A client tells the nurse, "I know I need to communicate more assertively, but I don't really know how." Which of these is the best response by the nurse? a. Inform the client that you will make a referral to an advanced practice nurse because generalist nurses are not within their scope of practice to teach assertiveness skills. b. Affirm that the client must know how to communicate assertively because they just did communicate their needs. c. Instruct the client that as long as they use "I" statements their communication will be assertive. d. Ask the client to further describe their concerns and offer to provide education in assertiveness skills.
D
. A client who has been in rehabilitation for alcohol dependence returns from a visit to his home and tells the nurse, "We were having a celebration and I did have one drink, but it really wasn't a problem." The nurse notices that his breath smells of alcohol. Which of the following responses by the nurse demonstrates a motivational interviewing style of communication? a. "You are obviously not motivated to change, so perhaps we should discuss your discharge from the treatment program." b. "You need to abstain from alcohol in order to recover, so let me talk to the doctor about the consequences of your behavior." c. "Why would you destroy everything you've worked so hard to achieve?" d. "What do you mean when you say, 'It really wasn't a problem'?"
D
. Which of the following parts of the brain has control over the pituitary gland and autonomic nervous system, as well as regulation of appetite and temperature? a. Temporal lobe b. Parietal lobe c. Cerebellum d. Hypothalamus
D
. Which of the following parts of the brain is associated with multiple feelings and behaviors and is sometimes referred to as the "emotional brain"? a. Frontal lobe b. Thalamus c. Hypothalamus d. Limbic system
D
A client was involved in an automobile accident while under the influence of alcohol. She swerved her car into a tree and narrowly missed hitting a child on a bicycle. She is in the hospital with multiple abrasions and contusions. She is talking about the accident with the nurse. Which of the following statements by the nurse is most appropriate? a. "Now that you know what can happen when you drink and drive, I'm sure you won't let it happen again." b. "You know that was a terrible thing you did. That child could have been killed." c. "I'm sure everything is going to be okay now that you understand the possible consequences of such behavior." d. "How are you feeling about what happened?"
D
A client who has been diagnosed with schizophrenia and has been on medication for several months states, "I'm not taking that stupid medication anymore." Which of the following responses by the nurse demonstrates a motivational interviewing style of communication? a. "Don't you know that if you don't take your medication you will never recover?" b. "Why won't you cooperate with the treatment your doctor prescribed?" c. "Bill, the medication is not stupid." d. "Tell me more about why you don't want to take the medication."
D
A client who is angry with his psychiatrist says to the nurse, "He doesn't know what he is doing. That medication isn't helping a thing!" The nurse responds, "He has been a doctor for many years and has helped many people." This is an example of what nontherapeutic technique? a. Rejecting b. Disapproving c. Probing d. Defending
D
A nurse is approached by a mental health technician who states, "I need for you to do 15-minute checks on my clients because I've got too many other things to do." This has been a regular occurrence with the mental health technician, and other staff members have complained that this worker is "just being lazy." Which of these is the best response by the nurse? a. Commend the technician for using good "I" communication. b. Instruct the technician that his peers think he is just being lazy. c. Reinforce to the technician that everyone is busy. d. State to the technician the expectation that he will complete his assigned duties.
D
A nurse reports to the supervisor that a depressed client is refusing medication to treat his heart condition and states he "would rather just die." The nurse is not sure how to intervene because, although clients have a right to refuse medication, this client may be so depressed that his behavior represents risk for suicide. Which of these actions by the supervisor is a priority? a. Tell the nurse that medication will have to be given forcibly if the client continues to refuse medication. b. Instruct the nurse that, because the client is elderly, he is unable to make this decision and medication will need to be secretly mixed in his food. c. Educate the nurse that the physician has the final say so the nurse should ask the physician what to do. d. Activate appropriate hospital resources, such as an ethics committee, so this issue can be explored further.
D
Anna states that Lucky was her closest friend, and since his death, no one can ever replace the relationship they had. According to Maslow's hierarchy of needs, which level of need is not being met? a. Physiological needs b. Self-esteem needs c. Safety and security needs d. Love and belonging needs
D
Crises occur when an individual: a. Is exposed to a precipitating stressor. b. Perceives a stressor to be threatening. c. Has no support systems. d. Experiences a stressor and perceives coping strategies to be ineffective.
D
Joe is very restless and is pacing the room. The nurse says to Joe, "If you don't sit down in the chair and be still, I'm going to put you in restraints!" With which of the following legal actions might the nurse be charged because of this nursing action? a. Defamation of character b. Battery c. Breach of confidentiality d. Assault
D
Lucky's accident occurred when he got away from Anna while they were taking a walk. He ran into the street and was hit by a car. Anna cannot remember the circumstances of his death. This is an example of what defense mechanism? a. Rationalization b. Suppression c. Denial d. Repression
D
The nurse is working with a client in the anger-management program. Which of the following identifies actions associated with the working phase of the therapeutic relationship? a. The nurse and the client work together to identify goals for developing more adaptive ways to handle anger. b. The client expresses a desire to continue in the anger management program after the goals have been met. c. The nurse reviews the client's medical record and assesses his or her personal feeling about working with a client who abused their spouse. d. The nurse assists the client in practicing various techniques to effectively manage anger and provides positive feedback when the client attempts to improve maladaptive behaviors.
D
Which of the following parts of the brain is concerned with visual reception and interpretation? a. Frontal lobe b. Parietal lobe c. Temporal lobe d. Occipital lobe
D
4. A teen tells the school nurse her mother drinks too much and is intoxicated every day. The teen is afraid to invite friends over because of mother's behavior. This type of crisis is called: A. Crisis resulting from traumatic stress B. Maturational/developmental crisis C. Crisis reflecting psychopathology D. Dispositional Crisis
D. Dispositional Crisis
WHAT IS CONSIDERED THE MOST WIDELY RECOGNIZED RISK FACTOR FOR VIOLENCE IN A TREATMENT SETTING?
PAST HISTORY OF VIOLENCE
A client has a history of excessive drinking, which has led to multiple arrests for driving under the influence (DUI). The client states, "I work hard to provide for my family. I don't see why I can't drink to relax." The nurse recognizes the use of which defense mechanism? A. Projection B. Rationalization C. Regression D. Sublimation
• ANS: B The nurse should recognize that the client is using rationalization, a common defense mechanism. The client is attempting to make excuses and create logical reasons to justify unacceptable feelings or behaviors.
A widow of 23 years has not removed any of her husband's possessions including his slippers beside their bed. Which pathological grief response is being exhibited by this client? A. Inhibited grief response B. Prolonged grief response C. Delayed grief response D. Distorted grief response
• Correct answer: B• The prolonged grief response is characterized by intense preoccupation with memories of the lost person years after the loss has occurred. This is how this client has responded to her husband's death.
AN ANGRY CLIENT STATES TO THE NURSE, "YOU RED- HEADED SKINNY WITCH. YOU CAN'T TELL ME WHAT TO DO." WHICH APPROPRIATE INTERVENTION WOULD THE NURSE IMPLEMENT DURING THIS OUTBURST? A. REPRIMAND THE CLIENT FOR POOR JUDGMENT AND DEROGATORY REMARKS. B. RESPOND TO ANGRY EXPRESSIONS WITH MATCHING VERBALIZATIONS. C. OFFER SUPPORT BY THE USE OF EMPATHY AND THERAPEUTIC TOUCH. D. IGNORE INITIAL DEROGATORY REMARKS
•CORRECT ANSWER D.• DURING EXPRESSIONS OF ANGER AND AGGRESSION, IGNORING INITIAL DEROGATORY REMARKS CAN BE AN APPROPRIATE NURSING INTERVENTION. LACK OF FEEDBACK OFTEN EXTINGUISHES AN UNDESIRABLE BEHAVIOR.
THREE FACTORS ARE IMPORTANT CONSIDERATIONS IN IDENTIFYING EXTENT OF RISKS:
•PAST HISTORY OF VIOLENCE •CLIENT DIAGNOSIS •CURRENT BEHAVIOR
