4 Chapters for Coping
Which provides the best definition for mental illness? A) Inability to function in a manner that manages both external and internal stressors effectively B) Result of genetic or environmental alterations resulting in mental dysfunction C) Existence of cognitive dysfunction resulting in a lack of autonomy D) Manifestation of altered sensory perceptions
A) Inability to function in a manner that manages both external and internal stressors effectively.
A psychiatric-mental health nurse is working a booth at a local community college job fair. One of the participants comes to the booth and asks the nurse about the different types of conditions for which psychiatric-mental health nurses provide care. Which condition would the nurse most likely include in the response? (Select all that apply.) A) Issues involving self-mutilation B) Self-esteem issues related to loss of a limb C) Substance use disorders D) High health literacy issues for adherence E) Problems associated with family or group isolation
A) Issues involving self-mutilation B) Self-esteem issues related to loss of a limb C) Substance use disorders E) Problems associated with family or group isolation
Maintaining a therapeutic environment and promoting growth through role modeling are components of which basic level function? A) Milieu therapy B) Case management C) Health teaching D) Counseling
A) Milieu therapy
Which are functions of assertive community treatment? Select all that apply. A) Promotes continuity of outpatient care B) Reduces inpatient service use C) Increases the stability of people with serious mental illnesses D) Increases the likelihood of relapse E) Decreases availability of services
A) Promotes continuity of outpatient care B) Reduces inpatient service use C) Increases the stability of people with serious mental illnesses
The psychiatric nurse recognizes that excessive social communication with a client is to be avoided primarily due to which reason? To prevent the client from viewing the nurse as a friend rather than health care provider To prevent disruption of the time that is to be used for therapeutic communication To avoid giving the client the impression that the nurse is not interested in providing effective care To avoid making the client feel that the client's problems are not viewed as being serious
a
What occurs during the working phase of the nurse-client relationship? Evaluation of mutually identified goals Discussion of expectations of the relationship Assessment of client needs Discussion regarding termination of the relationship
a
When a 23-year-old client is admitted to the psychiatric unit after a suicide attempt, the client states the client is willing to speak to the nurse but only if the conversation remains confidential. Which is the nurse's best response? "Will this conversation involve your desire to harm yourself?" "You know that I can't keep secrets from your health care team." "Without your permission I can't give any information to anyone." "Don't you trust me to respect your right to confidentiality?"
a
When a client states, "I will solve my own problems without asking my family for help," which response by the nurse demonstrates a therapeutic use of self? "Asking for help from those who care about us isn't a sign of weakness." "Being self-sufficient is a sign of mental health stability." "Your family would want to help if you had a problem." "How do you plan to manage your problems without help?"
a
When engaged in a therapeutic relationship, the nurse's focus is on what? The client The self The environment The family
a
Which is an inaccurate statement regarding a preconception? It enables the nurse to get an accurate picture of the client's problems. It is a way that a person expects another to behave. It prevents people from getting to know one another. It may prevent the nurse from developing a therapeutic relationship with the client.
a
Which is not considered a step in the values clarification process? Assessing Choosing Prizing Acting
a
Which nursing intervention demonstrates congruence in a therapeutic nurse-client relationship? getting an appointment with the client at the time previously agreed upon discussing the client's request for additional privileges with the treatment team sharing examples of stress management techniques implementing restatement as a therapeutic communication method
a
Which observation should lead the nurse manager to recognize that countertransference is affecting the therapeutic effectiveness of an individual nurse on the unit? The nurse frequently refers to an elderly, cognitively impaired client as "my granny" The nurse is referred to as being in a relationship with a client by that client, and the client wants the nurse to accompany the client to the prom The nurse begins to experience the symptoms of depression and calls out sick The nurse asks to be transferred to another unit to avoid burnout and to work with different disorders
a
Which occurs when the nurse responds to the client based on personal unconscious needs and conflicts? Countertransference Exploration Self-disclosure Transference
a
Which term is used to describe general feelings or a frame of reference around which a person organizes knowledge about the world? Attitudes Values Beliefs Self-awareness
a
While providing care to a client with psychosis, the psychiatric nurse uses communication initially for which reason? Eliciting the client's cooperation through the establishment of trust Establishing mutual expectations for nursing interventions Facilitating the assessment process and the collection of a database Providing the client contact with a caring professional health care provider
a
A nurse understands that giving positive regard to the client helps in building trust for the nurse. Which actions are appropriate while conveying positive regard? Select all that apply. The nurse should address the client by name. The nurse should actively listen to the client. The nurse should respond openly to the client. The nurse should be available all the time for caring for the client. The nurse should give the responsibility of planning therapy to the client.
abc
A care area is implementing motivational interviewing. What skills will be implemented by the nurse for this technique to be successful? Select all that apply. self-awareness active listening empathetic linkages strong communication use of a variety of defense mechanisms
abcd
At the end of a 12-hour shift, the nurse overhears that a client that the nurse has cared for before is being readmitted to the mental health facility. The nurse says to the charge nurse, "I better stay around for a couple of hours. I am the only one the client will talk to." This is a warning sign that the nurse is experiencing which obstacle to establishing a therapeutic relationship? Judgmental attitudes Lack of self-awareness Excessive probing Partnership
b
The client presents with signs and symptoms of anxiety. What conversation initiated by the nurse demonstrates an ineffective therapeutic use of self? "How did the pain start?" "What types of dresses do you like wearing?" "Do you take a vegetarian or nonvegetarian diet?" "Do you want me to inform your spouse about your illness?"
b
The client tells the nurse, "I am regularly doing my sitting breathing exercises. Why do I still feel breathless while walking?" The nurse replies, "Sitting breathing exercises alone may not achieve the desired effects. You also should perform daily deep breathing exercises while walking. This should help you to reduce breathlessness while walking." According to the Peplau model, in which phase of the nurse-client relationship would this conversation occur? Orientation phase Identification phase Exploitation phase Termination phase
b
The nurse and client are discussing discharge plans. Which statement should the nurse make that demonstrates empathy for the client's fear of returning to a group home environment? "Don't you think you're ready to be independent?" "It can be scary to leave a place that you trust and feel supported." "Just think of all of the things you can do in the home that you can't do here." "You are more than ready to get out of here. Have faith in your accomplishments."
b
Which is a nurse's primary tool for treating clients with mental disorders? Psychotropic medications The therapeutic use of self Self-help groups Family education and therapy
b
The nurse is caring for a client recently diagnosed with a psychiatric illness. Which key areas should the nurse focus on while caring for this client? Select all that apply. Personal safety Preventing deterioration of mental status Promoting mental health Promoting physical health Ensuring adequate sedation with medication
bcd
Which situation would most likely indicate a violation of professional boundaries? Select all that apply. The nurse refuses a gift from a client and the client's family. The nurse strongly defends a client's behavior during a staff meeting. A nurse tells other staff that the nurse is the only one who understands the client. A nurse begins to spend increasing amounts of time with one client on the unit. A nurse reports information to the physician after the client asks that it be kept a secret.
bcd
A nurse who has worked with a client with post-traumatic stress disorder (PTSD) regularly for several months stares blankly at the nurse for a long time. The nurse understands that the client is dissociating. According to the Carper's patterns of nursing knowledge, which pattern of knowing is this indicative of? Ethical knowing Aesthetic knowing Personal knowing Empirical knowing
c
A nursing instructor is teaching a class on empathy. The instructor determines that the class needs additional education when the students identify that empathy involves what? Careful listening Being in touch with what the client is saying Feeling the same emotions that the client is feeling at a given time Having insight into the meaning of clients' thoughts, feelings, and behaviors
c
The most important tool of psychiatric nursing is the: physician. nurse. self. environment.
c
The nurse has a client who seems like the nurse's sister, with whom the nurse has a close and positive relationship. This phenomenon is best characterized by which term? Transference Free association Countertransference Reaction formation
c
Which would indicate that the nurse-client relationship has passed from the orienting phase to the working phase? The client has revitalized the relationship with the client's sister. The nurse has designated a specific time each day to interact with the client. The client expresses a desire to be mothered and pampered. The client recognizes feelings of anger and expresses them appropriately.
d
Who was responsible for much of the reform of the mental health care system in the 19th century? A) Dorothea Dix B) Sigmund Freud C) Florence Nightingale D) Hildegard Peplau
A) Dorothea Dix
During the 1800s, Pinel believed that the cure for mental illness was ... A) arrest and confinement. B) use of chains. C) placement outside of the community. D) moral treatment.
D) moral treatment
A nurse is reading a journal article about the evolution of psychiatric-mental health nursing. Which individual would the nurse identify as being the first to address the education of psychiatric nursing? A) Effie Taylor B) Hildegarde Peplau C) Harriet Bailey D) Linda Richards
A) Effie Taylor
A nurse is reviewing the various events associated with the development of psychiatric-mental health nursing as it is today. Place the events in the order in which they occurred from oldest to most recent. 1) Certification of specialists in psychiatric-mental health nursing was initiated. 2) Standards of Child and Adolescent Psychiatric and Mental Health Nursing Practice were released. 3) Standards of Psychiatric-Mental Health Nursing Practice were released by the American Nurses Association. 4) Mental Health Nursing textbook by Harriet Bailey was published. 5) Interpersonal Relations in Nursing by Hildegarde Peplau was published.
4; 5; 3; 1; 2
Which theorist was most widely known for the belief that the cornerstone of all nursing care is the therapeutic relationship? Hildegard Peplau Jean Watson Florence Nightingale Clara Barton
A
How can a nurse best assure the management of personal long-term self-reflection that is associated with professional interaction with clients? A) Engage in regular discussions with a formal clinical supervisor B) Regularly reflect from the client's point of view C) Keep a journal that focuses on personal feelings D) Communicate with peers working in similar client environments
A) Engage in regular discussions with a formal clinical supervisor.
In terms of causing disability among people aged 15 to 44 years of age in North America, where does mental illness rank? A) First B) Fourth C) Second D) Third
A) First
The greatest impact case management has had on mental health care is that it has caused what? A) Has increased client access to appropriate mental health care B) Has affected public awareness of mental health care needs C) A focus on an illness, not a health paradigm D) Has stimulated an interest in professional mental health careers
A) Has increased client access to appropriate mental health care
The nurse is planning care for clients in a forensic setting. Which supports a trusting nurse-client relationship? A) Health teaching B) Personal conduct C) Maintaining boundaries D) Conducting exercise sessions
A) Health teaching
The psychiatric mental health nurse is planning the care of a client. What action best addresses the client's needs in the social domain? A) Collaborating with the client's family to organize support B) Administering a scheduled dose of an atypical antipsychotic C) Dialoguing with a client about the client's feelings around a traumatic event D) Teaching the client skills for identifying behavioral triggers
A) Collaborating with the client's family to organize support.
The nursing instructor asks the student to perform an assessment of a mentally ill client. What should the student do when executing this task? A) Collect comprehensive data B) Diagnose the problem C) Plan alternative interventions to attain the outcome D) Identify the outcome
A) Collect comprehensive data
The Substance Abuse and Mental Health Services Administration (SAMSHA)estimates that more than what percentage of Americans aged 18 years and older has a diagnosable mental disorder? A) 18.6% B) 13% C) 39.2% D) 52%
A) 18.6%
Deinstitutionalization has reduced the number of public hospital beds by what percentage? A) 80% B) 90% C) 70% D) 60%
A) 80%
What are the individual factors a nurse has to be aware of that may influence the mental health of a client with schizophrenia? Select all that apply. A) Biological makeup B) Intimacy C) Self-esteem D) Vitality E) Connectedness
A) Biological makeup C) Self-esteem D) Vitality
A client demonstrates sexually inappropriate behavior toward a student nurse. What is an effective way for the student to respond while protecting and respecting the client? A) Report the incident to staff and the clinical instructor so boundaries can be reenforced with the client. B) Immediately inform the client that the behavior is unacceptable and will be reported to staff. C) React to the incident with a sense of humor at the time but minimize contact with the client in the future. D) Ignore the behavior at the time it occurs but report it to staff before leaving clinicals for the day.
A) Report the incident to staff and the clinical instructor so boundaries can be reenforced with the client.
A college's nursing program has added an elective in forensic nursing to the curriculum. Which phenomenon underlies the expanded role for forensic nursing that is expected in the future? A) The fact that there are high rates of mental illness among the populations of jails and prisons B) The fact that most crimes are committed by people who have mental illness C) The fact that many states now require all prison inmates to be assessed by a mental nurse daily D) The fact that people with mental illness are the most common victims of crime
A) The fact that there are high rates of mental illness among the population of jails and prisons
One of the primary reforms accomplished by Dorothea Lynde Dix was the ... A) establishment or enlargement of state hospitals. B) use of music to treat mentally ill clients. C) use of exercise therapy to treat mentally ill clients. D) establishment of "commitment" laws in state legislatures.
A) establishment or enlargement of state hospitals
Which statement would indicate that the nurse has a non-judgmental attitude? "People who are mentally ill have basically weak characters." "The client has struggled with her life circumstance of living with a man who beats her, and she is trying very hard to make the changes necessary to help herself." "I think the client is exaggerating her feelings so she can leave work early." "Mental illnesses are, for the most part, all in your head and could be solved more easily if people were forced to continue with their daily activities, instead of listening to their complaints."
B
When comparing homeless people without mental illness to homeless people with mental illness, homeless people with mental illness: A) face fewer barriers to employment. B) spend less time in shelters. C) have more contact with family members. D) spend more time in jail.
D) spend more time in jail
When discussing instutionalization, which issue would most likely be considered a major problem associated with large state institutions? Select all that apply. A) Financial costs increased to individual residents B) Clients were not given proper nutrition or clothed properly C) Clients were isolated from family and community D) Sophisticated biologic treatments were unsuccessful E) Attendants were accused of torturing female residents
B) Clients were not given proper nutrition or clothed properly C) Clients were isolated from family and community E) Attendants were accused of torturing female residents
A forensic nurse working in a prison must view all clients as people who deserve respect and professionalism. What should the nurse do to enforce this viewpoint? A) Apply religious beliefs to patient care. B) Conduct ongoing self-reflection and self-awareness. C) Apply the nurse's morals and values to everyone. D) Conduct thorough physical assessments of clients.
B) Conduct ongoing self-reflection and self-awareness.
When describing the historical aspects of psychiatric-mental health care, the nurse addresses the changes in thought about the cause of mental illness from 0 to 1000 CE. Which cause would the nurse most likely identify as the belief during this period? A) Contaminated environments B) Demonic control C) Personal failure D) Physical illness
B) Demonic control
The nurse recognizes that public education is needed to erode stigma to prevent what? A) Stereotyping B) Discrimination C) Labeling D) Devaluing
B) Discrimination
When reviewing the evolution of mental health care in the United States, a psychiatric-mental health nurse reads about the creation of state hospitals for mental health care. The nurse would attribute this concept of care as the idea supported by: A) Horace Mann. B) Dorothea Dix. C) Clifford Beers. D) Sigmund Freud.
B) Dorothea Dix.
Initially, the nurse should focus on successfully achieving which goal in order to effectively provide care for a client diagnosed with a mental illness? A) Promoting friendship within the relationship B) Establishing trust and rapport with the client C) Offering sound advice concerning the client's primary problem D) Setting reasonable limits early in the relationship
B) Establishing trust and rapport with the client
The nurse knows the written instructions for healthcare when a person is incapacitated is called A) Informed consent B) Advance directive C) Living will D) Durable Power of Attorney
B) Advance directive
What percentage of adults requiring mental health services get the care they need? A) 35% B) 25% C) 5% D) 15%
B) 25%
A psychiatric client's nurse case manager best explains to the family that case management will facilitate the client's transition back into the community by providing which services? A) Facilitating reimbursement and coverage by the client's private and public insurances B) Identifying and meeting the client's health and human service needs C) Contacting and maintaining relationships with the client's various service providers D) Prescribing nursing care directed toward managing the client's acute and chronic health problems
B) Identifying and meeting the client's health and human service needs
Which statement is true concerning clients with dual diagnoses? A) Few mentally ill individuals have a confirmed dual disagoses B) Integrated care is preferred over split care for the separate diagnoses C) Clients will dual diagnoses generally receive adequate treatment for both mental health issues D) Intellectual disabilities are not considered as a possible dual diagnosis
B) Integrated care is preferred over split care for the separate diagnoses
Until the onset of the Renaissance, the general population held which belief regarding the presence of sickness? A) It was a consequence of inadequate parenting. B) It was punishment for sins and wrongdoing. C) It was a weakness in physical strength. D) It was based on social class.
B) It was punishment for sins and wrongdoing.
Medical insurance coverage for medical illnesses is greater than for psychiatric illnesses. What term best describes this discrepancy? A) Limited access to services. B) Lack of parity. C) Medical noncompliance. D) Stigmatism related to medical coverage.
B) Lack of parity.
The Fountain House in New York developed the clubhouse model in the 1940s. Which is an important characteristic of a clubhouse? A) Membership is time limited. B) Members receive mental health treatment from providers in the community. C) The clubhouse is run by staff members. D) Members live at the clubhouse.
B) Members receive mental health treatment from providers in the community.
Which federal law prevents insurance companies from enforcing annual or lifetime dollar amounts to be paid for mental health care? A) National Mental Health Act B) Mental Health Parity Act C) Patient Protection and Affordable Care Act D) Action for Mental Health
B) Mental Health Parity Act
The goal of deinstitutionalization movement was to achieve which outcome? A) Empty out large psychiatric hospitals so they could be converted for military use. B) Move psychiatric clients out of the hospitals and into the community in an effort to provide a better quality of life for them. C) Move psychiatric clients out of the hospitals and into their families of origin because of the belief that families were the responsible parties. D) Move chronic, older psychiatric clients out of hospitals to make room for younger clients who had better prognoses and were amenable to long-term treatment.
B) Move psychiatric clients out of the hospitals and into the community in an effort to provide a better quality of life for them.
Which intervention is appropriate for a psychiatric-mental health nurse at the basic level of practice? A) Conducting family therapy B) Promoting symptom management C) Interpreting laboratory tests D) Managing psychotropic medications
B) Promoting symptom management
Which is a criterion for mental health? A) Absence of sadness or anger B) Satisfaction with personal relationships and self C) Absence of mental health disorders D) No observable demonstration of deviant behavior
B) Satisfaction with personal relationships and self
Which is necessary as a defining feature in mental illness? A) The individual must acknowledge that he or she is having difficulties in functioning. B) The individual must have difficulties in functioning that cause distress and/or impairment of some type. C) The individual must have physiological symptoms that match with behaviors that are impaired. D) The individual must need medications in order for the diagnosis to be of psychiatric origin.
B) The individual must have difficulties in functioning that cause distress and/or impairment of some type.
A psychiatric-mental health nurse is describing the various programs offered by the local community mental health center. When explaining how these programs work, the nurse would emphasize which concept? A) autocratic leadership B) collaboration C) complete autonomy D) paternalistic decision-making
B) collaboration
Which client may be the most appropriate candidate for telepsychiatry? A) An inpatient who is on visual checks every 15 minutes as a suicide precaution B) A client who has been brought to the emergency department because of acute psychosis C) A client whose depression does not warrant inpatient or outpatient care but who is motivated to maintain the client's health D) A client with bipolar disorder who has been admitted to the hospital during a manic episode
C) A client whose depression does not warrant inpatient or outpatient care but who is motivated to maintain the client's health
A psychiatric-mental health nurse is asked to be a guest speaker at a community fund-raising event for mental health services. Which would the nurse emphasize as the primary focus of the current consumer movement and mental health services? A) Effective treatment for mental health care needs B) Access to affordable mental health care C) Recovery from mental illness as a realistic goal D) Removal of exclusions because of preexisting conditions
C) Recovery from mental illness as a realistic goal
Which is a result of deinstitutionalization? A) An improvement in community-based programs' ability to get funding B) An increase in available community resources C) A "revolving door" of repetitive hospital admissions D) The improvement of the ability of people diagnosed with mental illness to achieve independence
C) A "revolving door" of repetitive hospital admissions
A psychiatric-mental health nurse is preparing a presentation about the historical evolution of current psychiatric-mental health treatment. When describing the impact of Sigmund Freud's work on care, which information would the nurse most likely include? Select all that apply. A) Focus on the physiological aspects of mental illness B) Application of conscious motivations for behavior C) A disturbance in personality development as an underlying issue D) Use of psychoanalysis to address the underlying injury E) Short-term use of medication therapy to correct the cause
C) A disturbance in personality development as an underlying issue D) Use of psychoanalysis to address the underlying injury
Which individual has experienced the consequences of deinstitutionalization? A) A man who has been unable to obtain health insurance but who receives Medicare benefits B) A man who was denied inpatient psychiatric treatment by his health maintenance organization (HMO) C) A woman who was transferred from a psychiatric hospital to the community because of the hospital's impending closure D) A woman who has been the frequent object of stigma due to her history of psychiatric illness
C) A woman who was transferred from a psychiatric hospital to the community because of the hospital's impending closure.
When comparing the theories of mental illness popular in ancient Greece with those popular in the Middle Ages, which is more applicable to the Middle Ages? A) Mental illness was considered a disturbance of the four body fluids, or "humors." B) Emotional disorders were believed to be an organic dysfunction. C) Belief in demonic possession and exorcism was common. D) Treatment included sedation, good nutrition and hygiene, and music and recreation.
C) Belief in demonic possession and exorcism was common.
In early Christian times, what was thought to cause mental illness? A) Personal failure B) Contaminated environments C) Demonic control D) Sin
C) Demonic control
The nurse has been unsuccessful in the psychiatric clinical placement and will be obliged to repeat it next semester. The criteria for passing or failing were based on the Psychiatric-Mental Health Nursing Scope and Standards of Practice, which are? A) Explanations of the ideal character of the psychiatric or mental health nurse B) Future goals for the nursing profession as a whole C) Descriptions of the responsibilities for which nurses are accountable D) The legal documents that allow a nurse to practice
C) Descriptions of the responsibilities for which nurses are accountable.
Freud's personality theory was based on what? A) Social attributes B) Symbols C) Drives D) Impaired functioning
C) Drives
What is the primary benefit of the DSM-5 to the student nurse's practice with the mentally ill population? A) Provides insight into the effects of environmental problems the client may be facing B) Identifies medical conditions that could be contributing to decline of the client's mental health status C) Encourages the building of a knowledge base about the nature of psychiatric illnesses. D) Facilitates communication with other mental health care providers through a standardized language
C) Encourages the building of a knowledge base about the nature of psychiatric illnesses.
Which is a difference between counseling and psychotherapy? A) Counseling may be used in the care of acutely psychotic clients, but psychotherapy is contraindicated. B) Transference and countertransference are significant obstacles in psychotherapy that can be avoided in a counseling mode. C) Generalist psychiatric nurses may perform counseling interventions, but psychotherapy is an advanced practice role. D) Psychotherapy is reserved for clients who have a documented history of failing to respond to counseling.
C) Generalist psychiatric nurses may perform counseling interventions, but psychotherapy is an advanced practice role.
When providing care to a client, the psychiatric-mental health nurse is implementing the therapeutic use of self. The nurse is applying the concepts based on the work of which individual? A) Florence Nightingale B) Sigmund Freud C) Hildegard Peplau D) Dorothea Dix
C) Hildegard Peplau
Who was the first to introduce the concept of interpersonal relations and the therapeutic relationship? A) Florence Nightingale B) Linda Richards C) Hildegard Peplau D) Mary Nutting
C) Hildegard Peplau
Which is a true statement regarding Medicaid? A) It covers people with certain disabilities. B) It covers people 65 years of age and older. C) It covers individuals and families with low incomes. D) It covers people with permanent kidney failure.
C) It covers individuals and families with low incomes.
Who was the first trained nurse in the United States? A) Hildegard Peplau B) Florence Nightingale C) Linda Richards D) Effie Taylor
C) Linda Richards
A nurse is conducting a review class for a group of psychiatric-mental health nurses about the changes in psychiatric care that have occurred through the years related to legislation and policy initiatives. The nurse determines that the teaching was successful when the group identifies that supporters of the Community Mental Health Centers Construction Act (1963) believed that institutionalization was contributing to what? A) Financial problems B) Abuse of psychopharmacology C) Mental Illness D) Overpopulation
C) Mental Illness
The application of psychiatric mental health nursing theory to promote holistic client care in the therapeutic relationship is grounded in the work of which historical figure? A) Benner B) Freud C) Peplau D) Dix
C) Peplau
Which sets professional standards of care? A) Provinces B) States C) Professional nursing organizations D) Hospitals
C) Professional nursing organizations
The following events are important in the development of psychiatric-mental health nursing practice. Which event occurred first? A) Establishment of the first graduate program in psychiatric nursing at Rutgers University B) Publication of Standards of Psychiatric-Mental Health Nursing by the ANA C) Publication of the first psychiatric nursing text, Nursing Mental Disease, by Harriet Bailey D) Publication of Standards of Child and Adolescent Psychiatric and Mental Health Nursing Practice
C) Publication of the first psychiatric nursing text, Nursing Mental Disease, by Harriet Bailey
What nursing action demonstrates the intended impact of the American Nurses Association (ANA) standards of care on mental health nursing care? A) Using the standards to determine if a nurse's action is considered criminally negligent. B) Citing the standards as a guide for determining the delegation of care. C) Referring to the standards to determine if a particularly prescribed treatment falls within the scope of a nurse's practice. D) Using the standards as a guide to identify advanced level nursing functions.
C) Referring to the standards to determine if a particularly prescribed treatment falls within the scope of a nurse's practice.
A psychiatric-mental health registered nurse is studying the impact of factors like safety, effectiveness, and cost on the practice and delivery of nursing services. What is this process called? A) Professional practice evaluation B) Leadership C) Resource utilization D) Quality of practice
C) Resource utilization
The parents of a client with a mental illness being cared for at home tell the nurse that they have been feeling overwhelmed lately. They say, "We need to get away for a few days to recharge ourselves." Which care setting should the nurse recommend? A) Psychosocial rehabilitation B) Recovery center C) Respite residential care D) Assertive community treatment (ACT)
C) Respite residential care
One major reason that clients with mental disorders are rehospitalized is what? A) Severe side effects of antipsychotic agents B) Diagnosis of comorbid diseases C) Resurfacing of acute symptoms D) Need for close supervision by medical personnel
C) Resurfacing of acute symptoms
A client with mental illness expresses interest in having a date with the nurse. Which would be the nurse's best response in this situation? A) Yield to the client's desire, as the client has mental illness. B) Ask to be assigned another client. C) Set boundaries of a professional relationship. D) Scold the client for the inappropriate request.
C) Set boundaries of a professional relationship.
A psychiatric-mental health nurse is working on a committee that is developing programs that integrate the objectives for mental health and mental disorders, as identified in Healthy People 2020. Which type of program would be least appropriate? A) Employment programs for those with serious mental illness B) Depression-screening programs for primary care providers C) Single substance abuse treatment programs D) Mental health programs for the homeless population
C) Single substance abuse treatment programs
A client is in need of a family-like environment with a high level of support. Which would be most appropriate? A) Personal care home B) Supervised apartment C) Therapeutic foster care D) Board-and-care home
C) Therapeutic foster care
A client will soon be completing a course of inpatient treatment for the treatment of schizophrenia. At what point should the care team review the client's eligibility for additional services, coverage, and programs in the community? A) When requested by the client's health maintenance organization (HMO) B) When the client and/or client's family advocates for such a review C) Upon admission to the inpatient setting D) Once the client experiences an exacerbation of symptoms
C) Upon admission to the inpatient setting
During the moral treatment period, clients were routinely placed into which environment? A) psychosocial rehabilitation centers B) group homes C) asylums D) community mental health centers
C) asylums
The parents of a young adult diagnosed with schizophrenia are providing care for the client in their home. During a home visit, the parents state, "It's been so difficult taking care of our child. We need a break. But our child needs constant supervision." Which would be appropriate for the nurse to suggest? A) Partial hospitalization B) Acute inpatient care C) Intensive outpatient program D) Respite residential care
D) Respite residential care
A nurse is reading a journal article about practices involved during the moral treatment movement in psychiatric-mental health care. Which practice would most likely be included as being used during this time? A) exorcisms B) blood letting C) incarceration D) asylums
D) asylums
A nurse is providing community education about the prevention of mental illness. In response to the question, "What does it mean to be mentally healthy?" which is the nurse's bestresponse? A) "Mental health is defined as behavior accepted as normal by the major cultural group." B) "Mental health is difficult to define and depends on cultural norms." C) "Mental health is the absence of mental illness." D) "Mental health is marked by productivity, fulfilling relationships, and adaptability."
D) "Mental health is marked by productivity, fulfilling relationships, and adaptability."
Approximately what percentage of homeless people suffer from a severe psychiatric illness of a chronic substance use disorder? A) 60% B) 85% C) 75% D) 42%
D) 42%
Which best defines a community support system in relation to mental illness? A) An organized system of group housing arrangements designed to support the deinstitutionalization of the mentally ill B) A system of interventions designed to affect macrosystem variables that discriminate against people with mental illness C) A network of 12-step programs and support groups D) A network that helps to meet the needs of people with mental illness and to realize their potential without unnecessary isolation
D) A network that helps to meet the needs of people with mental ill
Chlorpromazine is a drug in which classification? A) Antianxiety B) Antidepressant C) Antimanic D) Antipsychotic
D) Antipsychotic
Initiatives that strive to strengthen the coordination of care involves cooperation and what? A) Duplication B) Individualization C) Promptness D) Collaboration
D) Collaboration
Which activity is a function solely of the advanced practice psychiatric-mental health nurse? A) Conducting milieu therapy B) Intake screening and evaluation C) Counseling and crisis management D) Conducting individual psychotherapy
D) Conducting individual psychotherapy
A nursing instructor informs a class that the trend in the United States today is to receive treatment without institutional-based intervention. What else is true concerning mental health care today? A) Changes in health care reimbursement have had no effects on outcomes. B) Treatment settings for patients with mental illnesses have remained constant the last century. C) Insurance and Medicaid/Medicare are lenient in regards to payment for this care. D) Criteria for admission to inpatient care have become legally regulated.
D) Criteria for admission to inpatient care have become legally regulated.
Assertive Community Treatment (ACT) reduces the use of which type of service? A) Community based B) Detoxification C) Crisis intervention D) In-patient Hospital
D) In-patient Hospital
Which is the most influencing factor that complicates the treatment of people with mental illness in the Unites States? A) Overuse of the well-coordinated mental health care system B) Increased responsibility for care by state mental hospitals C) Lack of effective treatments D) Insurers' reimbursement decisions
D) Insurers' reimbursement decisions
Which statement accurately describes the clubhouse model of community-based mental health rehabilitation? A) Focus is on illness, not health. B) Staff ultimately makes decisions about treatment. C) Taking prescribed drugs is a condition to participation. D) It exists to promote rehabilitation alliance.
D) It exists to promote rehabilitation alliance.
Which is an inaccurate depiction of self-awareness? A) There is an understanding that a nurse's belief may conflict with the client's. B) It involves self-reflection. C) The nurse gains recognition of his or her feelings and beliefs. D) It involves changing one's values or beliefs.
D) It involves changing one's values or beliefs.
A client diagnosed with schizophrenia has recently become divorced and is living in public housing. How would the DSM-5 best help in planning this client's care? A) It provides the mental health team with links to the latest clinical research on schizophrenia. B) It provides information on all major mental health disorders and their effect on existing health issues. C) It is used by all mental health professionals to identify and treat the mentally ill client. D) It is used by the mental health team to identify the psychosocial and environmental factors currently affecting the client.
D) It is used by the mental health team to identify the psychosocial and environmental factors currently affecting the client.
A nurse is reviewing the historical trends impacting the practice of psychiatric-mental health nursing practice. The nurse demonstrate understanding of the information by identifying which individual as being resonsible for opening the first training school for nurses in 1882? A) Hildegard Peplau B) Dorothea Dix C) Florence Nightingale D) Linda Richards
D) Linda Richards
Which would be most important for the nurse to do in order to maximize client adherence with the discharge plan? A) Encouraging the client to ask for help B) Telling the client to adhere to the plan C) Monitoring the client continuously D) Partnering with the client from the beginning
D) Partnering with the client from the beginning
The nurse is busy preparing a client for a procedure. The nurse may obtain a clients' signature on a form, but obtaining informed consent for the procedure is the responsibility of the A) Supervisor B) Manager C) OR Technician D) Physician
D) Physician
Which is a clinical activity of only the advanced practice registered nurse? A) Triage B) Milieu therapy C) Crisis intervention D) Psychotherapy
D) Psychotherapy
Which mental health service is an advanced-level function? A) Milieu therapy B) Self-care activities C) Counseling D) Psychotherapy
D) Psychotherapy
A client relates that the client has panic attacks and, during the attacks, rushes to the emergency department because the client feels like the client is dying. The nurse discloses that the nurse has had panic attacks during which the nurse also felt very fearful. Which statement represents an accurate statement about this self-disclosure? Self-disclosure can help normalize the client's experience. Self-disclosure allows the client to see the nurse as a real human being. Self-disclosure can help the client feel like a friend. Self-disclosure should be detailed so the client doesn't feel unimportant or devalued.
a
A client tells the mental health nurse that the client is taking a sewing class to cope with the client's son's move to another state. The use of this adaptive coping skill is an example of which aspect in the therapeutic relationship? Client self-exploration Self-disclosure Empathy Respect
a
A nurse has been working for 15 hours continuously without a break. The nurse administrator insists that the nurse should go home and sleep. According to the Carper's patterns of nursing knowledge, which pattern of knowing is this indicative of? Ethical knowing Aesthetic knowing Personal knowing Empirical knowing
a
A nurse is meeting a client for the first time. The nurse observes that the client smiles appropriately but is using rambling speech while answering the nurse's questions. Which would most likely be the reason for this behavior? The client is nervous and insecure. The client is experiencing symptoms of a disorder. The client is demonstrating a normal reaction. The client is attempting to engage in a social relationship.
a
A nurse recently began working with a client in the community. The client arrived 15 minutes late for the last appointment and did not show up for today's scheduled appointment, despite confirming the day before. How should the nurse best interpret this client's behavior? The client is testing the parameters of the relationship. The client is in denial about the severity of the illness. The client mistrusts the nurse's ability to promote recovery. The client's illness is being treated by another clinician.
a
A nursing student is working with a client who has a history of abusing alcohol. Although the nurse has an aversive feeling toward people who abuse alcohol, the nurse feels that the client is worthy of respect and attention regardless of the nurse's own personal feelings. Which correctly describes the nurse's response to the client? Unconditional positive regard Countertransference Partnership Genuineness
a
After teaching a class about the phases of the therapeutic relationship, the instructor determines a need for additional education when the class identifies which as a goal of the working phase? Develop a sense of trust within the relationship. Identify previous ineffective behaviors for coping with the problem Promote a supportive healing process Develop a plan of action with appropriate strategies
a
Avoiding which outcome is the primary reason for establishing professional boundaries with clients? The loss of therapeutic effectiveness The possibility of losing control of the milieu The likelihood of a client becoming too dependent on the nurse The possibility of inappropriate sexual tension developing
a
During a first meeting a client asks that information shared will not be relayed to immediate family members. Which should the nurse say in response? "Any information is only shared with other professionals involved in your care." "Is there some reason why you don't want your family to know your problems?" "I cannot promise that. Your family may ask me questions and I will need to answer truthfully." "It depends upon what they ask me. I might be able to withhold some information, but not all."
a
During an individual therapy session, a nurse is listening to a client describe the client's drug addiction. The client says, "I know I am doing the wrong thing for my kids, but I just can't stop using drugs." The nurse maintains eye contact and nods occasionally. The nurse responds by saying, "You're going through a difficult time." The nurse's actions and words are an example of: empathy. sympathy. apathy. nontherapeutic communication.
a
During the orientation phase of a nurse-client relationship, the nurse notes a change in the client's behavior. The client has forgotten a scheduled session and then accuses the nurse of breaking confidentiality. The nurse interprets this as suggesting what? Acting out Rejection of the nurse Dissatisfaction with the care Lack of understanding of the plan
a
During which phase of the nurse-client relationship does the client identify and explore specific problems? working debriefing orientation resolution
a
In what phase of the therapeutic relationship does the assessment process begin? During the initiating or orienting phase After the initiating or orienting phase has been completed During the working phase After the working phase has been completed
a
It is brought to the nurse administrator's attention that a nurse has developed an intimate relationship with a client. Which behavior indicates the nurse has engaged in an intimate relationship with a client? The nurse is having dinner with a client outside the hospital premises. The nurse is talking to the spouse of the client regarding the client's condition. The nurse examines the genital area of a client diagnosed with a sexually transmitted infection. The nurse speaks on topics like sports while performing assessment on the client.
a
The nurse is meeting with a client experiencing a mood disorder. Which client statement indicates that the nurse-client relationship has been established? "I feel worthless and have no real use in life." "I really don't want to talk about that right now." "What difference does it make what I say to you?" "I know you are busy. I don't have much to say now."
a
The nurse is reviewing the client's history, identifies themes, and considers how the nurse can be most therapeutic to a client who was recently admitted to a psychiatric unit. The nurse is functioning in which phase of the therapeutic relationship? Orientation Working Resolution Withholding
a
The nurse-client relationship is classified as which type of relationship? Therapeutic Social Intimate Friendly
a
A psychiatric-mental health nurse has developed a therapeutic relationship with a client. Which action would alert the nurse to the possibilty that the relationship may be moving outside professional boundaries? Select all that apply. The client brings the nurse a baked item for their lunch. The nurse is spending more time with the client than the others in the group. The nurse objectively contributes to the team meeting about behaviors the client is displaying. The nurse tells a friend that the nurse is the only one who truly understands this client. The nurse informs the supervisor that the client asked the nurse to "keep a secret from the rest of the staff."
abd
The manager schedules a staff nurse to attend a motivational interviewing training session. Which nurse behavior caused the manager to make this decision? Select all that apply. interrupting the client minimizing the client's concerns asking the client to clarify a particular issue arguing with a client over agreed upon plans restating the client's perception of a problem
abd
The nurse prepares to assess a client for the first time. Which action should the nurse take to develop a rapport with this client? Select all that apply. establish professional boundaries listen intently to the client explain problems and issues compliment the client regarding clothing selection explain what confidential information will be shared with others suggest that another nurse meet with the client because of arriving late
abd
The nurse and client are entering the resolution phase of the relationship. Which behaviors indicate that the client does not want the relationship to end? Select all that apply. skips the last session expresses anger towards the nurse and other clients lists actions to move forward at the conclusion of the meeting asks to keep in touch with the nurse after the relationship ends identifies a resolved problem as a new one needing to be addressed
abe
When interacting with a client for the first time, which information would be appropriate for the nurse to disclose? Select all that apply. Name Level of education Home address Family members Reason for being on the unit
abe
The manager is reviewing the implementation of the Transitional Relationship Model (TRM) on a care area. Which data should the manager identify that supports the successful implementation of this model? Select all that apply. discharge of clients 5 days earlier than in the past nurse reassignment increased 8% over the last month number of readmissions down 6% over the last 2 months client dissatisfaction with care up 10% over the last month staff attendance at educational programs down 9% over the last month
ac
A 68-year-old parent is the sole care provider for a 39-year-old child who has a diagnosis of bipolar disorder. The 39-year-old has been experiencing worsening of the illness over several years. The nurse should recognize that the parent is at risk for what? Bipolar disorder Compassion fatigue Failure to thrive Decompensation
b
A client expresses worry about the client's child's aggressive behavior. The nurse says "You are in a very challenging situation. Your child's aggressive behavior is very stressful for you, is this correct?" What does this nurse's statement indicate? The nurse is comforting the client. The nurse is empathizing with the client. The nurse is sympathizing with the client. The nurse is showing genuine interest in the client.
b
A nurse is caring for a client with hemiplegia who has been depressed. The client tells the nurse, "I don't feel I would ever be independent again. I would be a burden to everybody in my house." The nurse responds by stating, "Your family misses you a lot and wants you home as soon as possible. The rehab team is very confident about your progress." Which phase of nurse-client relationship is occurring? Orientation Working Resolution Mutual withdrawal
b
A nurse is conducting a 6-week social skills training program. A young adult with schizophrenia asks the nurse to call the client on the weekends so the client has someone to talk to who really cares. Which action should the nurse take? Tell the client the nurse will call once per week during office hours so that the client can practice phone skills Remind the client about the importance of boundaries to keep the relationship therapeutic Call the client once each weekend to build trust Tell the client to call the office answering service in case of an emergency
b
A nurse is speaking to a client who attempted suicide. The client says, "It is my dream to become a doctor, and I failed the entrance exam. I am so mad at myself." Which statement indicates genuine interest by the nurse? "You were killing yourself for this?" "You must have been really upset." "What would you gain by killing yourself?" "It is wrong to commit suicide."
b
A nurse is speaking to a client with a soft smile and eye contact. Which statement said by the nurse would indicate a congruent message? "Please don't disturb the other clients in the ward." "Your hard work and determination has helped you recover." "Please listen to the instructions carefully before starting the exercises." "I know you are in pain. Please wait until the medication shows its effect."
b
Which statement by the nurse demonstrates acceptance to the client who has made a sexually inappropriate comment? "That type of talk is inappropriate and won't be tolerated." "Why do you think making that comment is appropriate?" "How would you feel if someone said that to you?" "Our relationship is one of a professional nature."
d
A nurse administrator is observing the behavior of nurses in the hospital. Which behaviors would the nurse administrator consider inappropriate? Select all that apply. A nurse speaking to a client at a distance of 4 feet A nurse hugging a client who had come in for an initial visit A nurse palpating the neck of a client during the assessment A nurse speaking to a depressed client in a very strict, disciplinarian tone A nurse holding the hand of a client who is depressed because of the client's child's chronic illness.
bd
A female psychiatric client is talking to the nurse about her reasons for being hospitalized. The client begins to discuss her relationship with her female significant other. She is describing the things in her relationship that are making her uncomfortable, and she asks the nurse, "Should I break up with my partner?" Which response by the nurse would be most effective in building rapport between the client and nurse? "Of course you should; being a lesbian is just not natural." "Yes, I think you should pursue building a relationship with a man." "It sounds like you're beginning to be uncomfortable in this relationship." "You need to focus on yourself rather than the relationship right now."
c
A nurse is caring for a client with depression. The client says that the client cannot stop thinking about the client's dead spouse. Which self-disclosure example given by the nurse is mostappropriate? "My father passed away recently. I can understand your problem." "I just had a divorce; I can understand how it would feel to be without a partner." "I can understand your situation; my cousin lost a spouse a few months ago." "I can understand your situation. Medication could be of great help to relieve your depression."
c
A nurse is in the orientation phase of the nurse-client relationship with a client diagnosed with a mental disorder. When interviewing the client during this first encounter, which information about the client would be most important for the nurse to obtain? known allergies recent hospitalizations perception of the problem family history
c
A nurse is interviewing a client to obtain a health history. Which would be considered a "usual or expected" response during the first session? Showing up late for the first session Being confrontational with nurse and other group members Rambling due to nervousness Bragging about sexual conquests
c
A nurse notices that a neighbor has been admitted to an inpatient psychiatric unit. The nurse understands that the nurse may not discuss this with any of the nurse's family or neighbors, because doing so would breach the client's confidentiality. Confidentiality is a component of which element of the therapeutic relationship? Positive regard Caring Trust Genuine interest
c
The nurse learns that a new client is a former significant other and an initial session is scheduled for early in the afternoon. Which action should the nurse take to maintain professional boundaries? Plan to meet the client since the personal relationship ended. Ask another nurse to attend the meetings to ensure boundaries are not crossed. Ask to be reassigned because of having a prior personal relationship with the client. Meet for the first session but explain that another nurse will be assigned going forward.
c
What should the nurse avoid when demonstrating genuine interest for a client by making a self-disclosure? providing advice on how to manage a problem being too general with the details of the story shifting the emphasis to the nurse using situations that have occurred on the unit
c
Which is not involved in empathy? Careful listening Being in touch with what clients are saying Feeling the same emotions that the client is feeling at a given time Having insight into the meaning of clients' thoughts, feelings, and behaviors
c
A client arrives for a scheduled meeting with the nurse. Which statement should the nurse make that indicates the working phase of the relationship? "Thank you for arriving on time." "I do not give out my cell phone number to clients." "You have learned how to handle that problem already." "Your idea would help prevent this from happening again."
d
A client explains feelings of sadness and loss after the death of a close friend. Which nursing statement best demonstrates empathy? "I'm sorry for your loss." "It's hard to lose someone you love." "Maybe it will be better for your friend." "I see this is hard for you. How can I help?"
d
A client reveals in a therapy session that the client has thought about killing a neighbor. What is the therapist's obligation regarding this revelation? The therapist must keep the comment confidential, because the disclosure is protected by therapist-client confidentiality. The therapist must evaluate the threat and notify authorities if it meets credibility criteria. The therapist must meet with an ethics committee to determine the course of action. The therapist must notify authorities and the potential victim.
d
A nurse is assessing an adolescent client who has recently been self-mutilating. The nurse asks the client questions that seek to uncover the motivation underlying the behavior. The nurse's approach bestreflects what? The use of unconditional positive regard A demonstration of genuine interest The therapeutic use of self The exploration of behaviors to uncover the client perspective
d
A nurse is caring for a client experiencing delusions. The client tells the nurse "I am sure my brother has plans to kill me. But I am ready; I will be killing him before he tries to reach me." What is the appropriate action of the nurse in this situation? The nurse should sedate the client. The nurse should advise the client not to think this way. The nurse should inform that severe actions would be taken if the client repeats it. The nurse should notify to the primary healthcare provider.
d
A nurse is caring for a client with anxiety disorder. The nurse knows that the client will have dyspnea and tachycardia if she has an anxiety attack. According to the Carper's patterns of nursing knowledge, which pattern of knowing is this indicative of? Ethical knowing Aesthetic knowing Personal knowing Empirical knowing
d
A nurse is interacting with a client who is expressing feelings about the client's child's insensitive behavior. Which statement made by the nurse indicates the nurse is empathizing with the client? Choose the best answer. "Don't worry. Your child will be all right." "I don't know how you've managed to cope, this is awful." "That is unbelievable. How could you tolerate this behavior?" "It sounds like this is very difficult for you, I can see why it causes you stress."
d
During the next meeting during the working phase of the relationship the client brings the nurse homemade chocolate chip cookies and a box of chocolates. Which response should the nurse make to the client about these gifts? "Thank you so much. I will share them with the other nurses." "They look delicious and I love candy but I'm on a diet and really can't accept them." "How did you know that I'm a chocoholic? Will you have a cookie with me while we talk?" "Thank you but I will not accept these gifts because they extend over our discussed boundaries."
d
Termination takes place during the resolution phase of a nurse-client relationship. During the termination process, a client brings up resolved problems and presents them as new issues to work toward. The nurse interprets the client's action as indicating what? The client: is angry that the nurse is abandoning the client. requires additional therapy. is unhappy that the therapy was ineffective. is attempting to prolong the nurse-client relationship.
d
The nurse and client are entering the orientation phase of a relationship. Which is the goal for the client during this phase? work through problems resolve pressing problems identify potential solutions to issues develop a sense of trust in the nurse
d
The nurse maintains a therapeutic relationship until the client is successfully transferred to another facility. What is the nurse demonstrating? avoid and ignore mutual withdrawal motivational interviewing transitional relationship model
d
Which clinical situation provides an example of transference? A nurse implements the same interventions with multiple clients despite their personal differences. A nurse asks for clarification from a colleague when explaining a coping strategy to a client. A client mirrors the nursing student's nervousness and hesitancy during assessment. A female client with a history of sexual abuse exhibits a profound mistrust of male caregivers.
d
