9, 10, 14, 15

9. A 40-year-old female client has never experienced an intimate relationship. A nursing student tells an instructor that this client remains in Erikson's developmental stage of intimacy versus isolation. What is the instructor's most appropriate reply?

A. "Erikson's stages of development are assessed by chronological age, not task achievement. This client is in the generativity versus stagnation stage, which occurs from 30 to 65 years of age."

8. During a group discussion, members freely interact with each other. Which member statement is an example of Yalom's curative group factor of imparting information?

A. "I found a Web site explaining the different types of brain tumors and their treatment."

3. A nurse is running a group on self-esteem. A client asks, "Where does self-esteem come from?" Which is the most appropriate nursing reply?

A. "Many factors, over the life span, influence development and maintenance of self-esteem."

27. An adolescent client has problems expressing anger appropriately. Which nursing statement would encourage the client to set realistic goals?

A. "What do you think needs to change about how you express anger?"

6. During an assertiveness training group, a nurse suggests using "I statements." The group questions the usefulness of this communication technique. Which explanation by the nurse is most appropriate?

A. "When 'I statements' are used, opinions are communicated without blaming others."

15. One nurse confronts another and says, "You are always so talkative in the meetings. I don't know why you can't stay quiet sometimes." Which reply by the other nurse reflects the technique of "clouding/fogging?"

A. "You're right. I do speak up a lot."

23. A nurse is caring for four clients. Which of the following clients should the nurse identify as likely to experience difficulty in being assertive? Select all that apply.

A. A 20-year-old woman who is completing college homework assignments for several peers. B. A 69-year-old widow who is socially isolated C. A 17-year-old boy with conduct disorder

21. Which of the following observed client behaviors would lead a nurse to evaluate a member as assuming a maintenance group role? Select all that apply.

A. A client decreases conflict within the group by encouraging compromise. B. A client offers recognition and acceptance of others. D. A client listens attentively to group interaction.

13. The following outcome was developed for a client: "Client will list five personal strengths by the end of day 1." Which correctly written nursing diagnostic statement most likely generated the development of this outcome?

A. Altered self-esteem R/T years of emotional abuse AEB self-deprecating statements

20. A client is diagnosed with generalized anxiety disorder. In order to maximize the learning process prior to discharge teaching, which assessment should be performed by the nurse?

A. Assessing the client's level of anxiety

7. Which is an appropriate initial nursing intervention for a client with chronic low self-esteem?

A. Assessing the content of negative self-talk

31. Which of the following nursing interventions fall within the standards of psychiatric-mental health clinical nursing practice for a nurse generalist? Select all that apply.

A. Assist clients to perform activities of daily living. C. Encourage clients to discuss triggers for relapse E. Educate families about signs and symptoms of alcohol dependence and withdrawal

2. During a therapeutic group, two clients engage in an angry verbal exchange. The nurse leader interrupts the exchange and excuses both of the clients from the group. The nurse has demonstrated which leadership style?

A. Autocratic

2. Two clients are roommates on an inpatient psychiatric unit. At breakfast, client "A," who had been missing her gold locket, notices client "B" wearing it. Which should a nurse recognize as a nonassertive or passive behavioral response from client "A"?

A. Client "A" ignores the situation.

4. During a community meeting, a nurse encourages clients to present unit problems and discuss possible solutions. Which type of leadership style is the nurse demonstrating?

A. Democratic

16. A 47-year-old mother of two has recently undergone a radical mastectomy. She refuses to see anyone and remains isolated and withdrawn. Which of the following may be relevant nursing diagnoses for this client? Select all that apply.

A. Disturbed body image B. Situational low self-esteem C. Ineffective coping

14. A client has continual problematic relationships and rejects others before possibly being rejected. The client states, "I am afraid of failing in my job responsibilities." Which correctly written nursing diagnosis should be prioritized for this client?

A. Poor self-esteem R/T negative self-image AEB fear of failure

8. The nurse should recognize which acronym as representing problem-oriented charting?

A. SOAPIE

16. The following North American Nursing Diagnosis Association (NANDA) nursing diagnostic stem was developed for a client on an inpatient unit: Risk for injury. What assessment data most likely led to the development of this problem statement?

A. The client is receiving electroconvulsive therapy (ECT) and is diagnosed with Parkinsonism.

10. During an inpatient educational group, a client shouts out, "This information is worthless. Nothing you have said can help me." These statements indicate to the nurse leader that the client is assuming which group role?

A. The group role of aggressor

18. A 10-week, prenuptial counseling group composed of five couples is terminating. At the last group meeting, a nurse notices that the two most faithful and participative couples are absent. When considering concepts of group development, what might explain this behavior?

A. They are experiencing problems with termination, leading to feelings of abandonment.

15. A nurse is caring for a client who has recently undergone a radical prostatectomy. Which of the following should the nurse recognize as objective symptoms of low self-esteem? Select all that apply.

A. Withdrawal from activities B. A decrease in self-care behaviors C. Poor eye contact E. Poor posture

1. During a psychoeducational group on assertiveness training, a client asks, "Why do we need to learn about this stuff?" Which is the most appropriate nursing reply?

B. "Being assertive is the ability to stand up for yourself while respecting the rights of others."

12. During a group session, which client statement demonstrates that the group has progressed to the middle, or working, phase of group development?

B. "I think Joe's Antabuse suggestion is a good one and might work for me."

11. An emergency department nurse, who has worked 10 straight days, is pulled to the psychiatric unit. Which represents a passive-aggressive statement by the emergency department nurse?

B. "Okay. I'll do it," then purposefully leaves paperwork undone when leaving the unit at 11 p.m.

18. A client diagnosed with schizophrenia is exhibiting nonverbal behaviors indicating that the client is hearing things that others do not. Which nursing diagnosis accurately reflects this client's problem?

B. Altered sensory perception

4. A client continually waits more than an hour before being seen at the mental health clinic. The client approaches the nurse and states, "When I have to wait for more than an hour to be seen, I feel like my time is not important." The nurse recognizes this as what type of behavior?

B. Assertive behavior

2. Which statement is most accurate regarding the assessment of clients diagnosed with psychiatric problems?

B. Assessment provides a holistic view of the client, including biopsychosocial aspects.

2. A client shows a nurse a piece of artwork that took 3 days to create. How will this achievement improve the client's self-esteem?

B. By providing an expression of feelings and a sense of competence and pride

14. How should a nurse prioritize nursing diagnoses?

B. By the life-threatening potential

6. On the basis of Erikson's theory, how should a nurse encourage a 40-year-old client to improve his or her self-esteem?

B. Encourage the client to volunteer at a school, reading to underprivileged children.

22. Which of the following behavioral skills should a nurse implement when leading a group that is functioning in the orientation phase of group development? Select all that apply.

B. Ensuring that rules established by the group do not interfere with goal fulfillment C. Working with group members to establish rules that will govern the group D. Emphasizing the need for and importance of confidentiality within the group

7. A man diagnosed with alcohol dependence experiences his first relapse. During his AA meeting, another group member states, "I relapsed three times, but now have been sober for 15 years." Which of Yalom's curative group factors does this illustrate?

B. Instillation of hope

11. What is the purpose when a nurse gathers client information?

B. It enables the nurse to make sound clinical judgments and plan appropriate client care.

3. Which nursing diagnosis should a nurse identify as being correctly formulated?

B. Self-care deficit: hygiene R/T altered thought as AEB disheveled appearance

16. A teenager gets a "C" in algebra. The mother angrily states, "All you ever do is listen to music and text your friends." The teenager replies, "What is it that you're really upset about, mom?" Which response pattern is the teenager expressing?

B. Shifting from content to process

21. During the implementation phase of the nursing process, a nurse is teaching an adult depressed patient with a cochlear implant about medications. Which modification in the teaching plan would be the most appropriate for this client?

B. Speaking directly face-to-face

15. The nurse should utilize which group function to help an extremely withdrawn, paranoid client increase feelings of security?

B. Support

29. A client is assigned the nursing diagnosis of impaired social interaction R/T sociocultural differences AEB client stating, "Although I'd like to, I don't join in because I don't speak the language so good." Which correctly written outcome addresses this client's problem?

B. The client will participate in one group activity of choice by day 2.

1. During a therapeutic group, a client talks about personal accomplishments in an effort to gain attention. Which group role, assumed by this client, should the nurse identify?

B. The individual role of recognition seeker

19. A nursing instructor is teaching students about the purpose of using the nursing process in the care of psychiatric patients. Which of the following statements by the student indicates that learning has occurred?

B. The nursing process is used to assist patients to adapt successfully to stressors within the environment.

33. After a comprehensive assessment, correctly written nursing diagnoses developed for psychiatric clients may include which of the following components? Select all that apply.

B. Unmet client needs present at the moment C. Supporting data that validate the diagnosis E. Statements of client problems of a functional nature

6. Within the nurse's scope of practice, which function is exclusive to the advance practice psychiatric nurse?

B. Using psychotherapy to improve mental health status

5. Which situation should a nurse identify as an example of an autocratic leadership style?

B. Without faculty input, the dean mandates that all course content be delivered via the Internet.

9. Prayer group members at a local Baptist church are meeting with a poor, homeless family they are supporting. Which member statement is an example of Yalom's curative group factor of altruism?

C. "I can give you all of my baby clothes for your little one."

7. While trying to control aggressive behavior, a client asks an assertiveness training nurse to give an example of an "I statement." Which of the following statements is the best example of this assertive communication technique?

C. "I feel angry when you come home late without calling."

20. A nursing instructor is teaching about psychodrama, a specialized type of therapeutic group. Which student statement indicates that further teaching is necessary?

C. "In psychodrama, the client observes actor interactions from the audience."

20. A nurse has identified the following nursing diagnosis: "ineffective communication R/T lack of assertiveness skills AEB inability to state needs." Which statement encourages the client to acknowledge the priority of this problem?

C. "On a scale of 1 to 10, rank the importance of being assertive."

28. The nurse interviewed a client who was uncooperative, answered questions with minimal responses, and rarely made eye contact. Which is the most complete documentation of baseline data obtained during the interview?

C. "States 'I don't need to be here' when discussing admission status. Maintains minimal eye contact and offers little data related to triggers for admission."

17. A student nurse asks an instructor which resource is best to use when developing nursing outcomes for clients. Which reply by the instructor most accurately answers the student's question?

C. "Use the Nursing Outcomes Classification (NOC), as a reference for nursing outcomes."

19. An experienced psychiatric registered nurse has taken a new position leading groups in a day treatment program. Without further education, which group is this nurse most qualified to lead?

C. A parenting group

25. A client diagnosed with major depressive disorder states, "Why should I keep trying to get a job? I mess up everything I do." Which correctly written nursing diagnosis best reflects the content and mood themes in this client's statement?

C. Altered role performance R/T the fear of failure AEB not seeking employment

1. Which data-gathering technique is employed during the assessment phase of the nursing process?

C. Asking the client to describe any thoughts of self-harm

32. Which of the following are characteristics of accurately developed client outcomes? Select all that apply.

C. Client outcomes are specific and measurable. D. Client outcomes are realistically based on client capability.

16. When planning group therapy, a nurse should identify which configuration as most optimal for a therapeutic group?

C. Closed membership; circle of chairs; group size of 5 to 10 members

9. A nurse should assign which nursing diagnosis to a client needing assistance with assertiveness?

C. Defensive coping

5. The nurse is working with a 15-year-old client suffering from low self-esteem. According to Erikson's psychosocial developmental theory, which factor has most probably influenced this client's self-esteem?

C. Inconsistent, overly harsh, or absent parental discipline

17. The dean of nursing criticizes a faculty member about views on academic freedom. The faculty member states, "Are you upset because I believe in academic freedom or because you don't?" The faculty member is using which technique to promote assertive behavior?

C. Inquiring assertively

8. A 30-year-old client diagnosed with depression has been exclusively cared for and financially subsidized by his mother since age 17. According to Erikson's theory, the nurse recognizes that the client has been unsuccessful in meeting which developmental task?

C. Intimacy

9. Which tool would be appropriate for a nurse to use when assessing mental acuity prior to and immediately following electroconvulsive therapy (ECT)?

C. MMSE

12. A nurse on an inpatient psychiatric unit implements care by scheduling client activities, interacting with clients, and maintaining a safe therapeutic environment. These actions reflect which role of the nurse?

C. Milieu manager

5. Which statement regarding nursing interventions should a nurse identify as accurate?

C. Nursing interventions occur independently but in concert with overall treatment team goals.

10. What is being assessed when a nurse asks a client to identify name, date, residential address, and situation?

C. Orientation

1. A nurse is working in a nursing home. How best can this nurse foster self-esteem in the residents of this facility?

C. Providing a sense of mastery over their environment by giving choices when appropriate

12. A father tells his 5-year-old, "Son, today instead of picking flowers in the outfield, let's try to catch a ball." The child subsequently pays attention and catches a ball. Which principle of building self-esteem has the father implemented?

C. Realistic goals

19. When the supervisor says 'But I need you to work," the nurse repeats "I worked last Christmas and will not work this Christmas." This is an example of which assertive behavior technique?

C. Responding as a broken record

13. A nursing instructor is teaching about self-concept. Which student statement indicates a need for further instruction?

C. Self-concept is the degree of regard that individuals have for themselves.

10. A home health nurse visits an 18-year-old client who lives with his mother. The client has been assessed as having low self-esteem. The nurse refers the client for individual counseling. During the next home visit, which assessed client behavior clearly indicates treatment success?

C. The client tells his mother he plans to buy a dog.

30. The following clients are seen in the emergency department. The psychiatric unit has one remaining bed. The triage nurse should expect which client to be admitted?

C. The client who is a single parent and hears voices stating, "Kill your infant son."

15. A client has a nursing diagnosis of Insomnia R/T paranoid thinking AEB midnight awakenings, difficulty falling asleep, and daytime napping. Which is a correctly written and appropriate outcome for this client's problem?

C. The client will sleep 7 uninterrupted hours by day four of hospitalization.

11. A nurse believes that the members of a parenting group are in the initial, or orientation, phase of group development. Which group behaviors would support this assumption?

C. The group members compliment the leader and compete for the role of recorder.

3. During a therapeutic group, which nursing action demonstrates a laissez-faire leadership style?

C. The nurse sits silently as the group members stray from the assigned topic.

3. A client on an inpatient unit is angry with a peer. During lunch, when the peer is not looking, the client spits into his soup. How would the nurse document this interaction?

D. "Client is displaying passive-aggressive behaviors."

18. An aggressive nurse manager tells a staff nurse she has no business rallying staff to change the schedule. What would be an example of a technique that the staff nurse could use to stand up for her basic human rights?

D. "I have the right to express my opinion about the schedule."

26. During an intake interview, which question would assist the nurse in gathering data about the client's judgment?

D. "If you found a stamped, addressed envelope in the street, what would you do?"

13. Which is the most appropriate nursing reply when a client asks what the goal and benefit are of assertive skills training?

D. "It improves communication skills in order to improve interpersonal relationships."

24. Which nursing response would be appropriately used in the evaluation phase of the nursing process?

D. "It sounds like you're saying this new approach is working for you."

14. A nursing instructor is teaching students about self-help groups like Alcoholics Anonymous (AA). Which student statement indicates that learning has occurred?

D. "Members themselves run the group, with leadership usually rotating among the members."

14. An instructor is teaching about assertive rights. Which student statement indicates a need for further instruction?

D. "The right to always put oneself first is an assertive right."

5. During an assertiveness training group, a client admits to aggressive behaviors. The client asks for suggestions for how to become more assertive and less aggressive. Which is the most appropriate nursing reply?

D. "There are several techniques, including 'I statements,' role playing, and thought stopping, that can help promote assertive behaviors and decrease aggressive behaviors."

23. An instructor overhears a student say, "That family seems to disagree more than agree. The family seems to be dysfunctional." To further assess the family's situation, which would be an appropriate instructor reply?

D. "What appears to trigger family disagreements?"

11. A 40-year-old client lives with her parents. She has a high school diploma and works at a low-paying job. Her parents give her a weekly allowance to supplement her income. How should the nurse classify their client-parent boundaries?

D. As enmeshed

4. Which expected client outcome should a nurse identify as being correctly formulated?

D. Client will initiate interaction with one peer during free time within 2 days.

8. After vying for a nurse management position, nurse "A" is chosen over nurse "B." When nurse manager "A" calls for staff meetings, nurse "B" is chronically late or absent. Nurse "B" is exhibiting which type of behavior?

D. Passive-aggressive

22. A client who has slept 6 hours the previous night reports this to the assigned psychiatric nurse. What should be the initial nursing action to address this situation?

D. Review the client's normal sleep pattern.

13. Which group leader activity should a nurse identify as being most important in the final, or termination, phase of group development?

D. The group leader helps the members to process feelings of loss.

4. In what way should a nurse expect a school-aged child to gain positive self-esteem, according to Erikson's psychosocial developmental stages?

D. Through receiving recognition when learning, competing, and performing successfully

17. During the sixth week of a 10-week parenting skills group, a nurse observes as several members get into a heated dispute about spanking. As a group, they decide to create a pros-and-cons poster on the use of physical discipline. At this time, what is the role of the group leader?

D. To encourage the group to solve the problem collectively

22. A client is experiencing high stress. The client states, "My boss treats me like a doormat and thinks nothing of demanding frequent overtime." Which nursing intervention would be appropriate?

D. To teach the client how to use "I" statements

12. Which best describes a nurse's use of assertive behavior?

D. When a nurse is open and direct when asked by the nurse manager to complete assignments

10. Two clients get into a heated argument regarding TV program selections. The nurse turns off the TV and asks the clients to go to their rooms to cool off, after which they will discuss and attempt to resolve the problem. The nurse's action is promoting which assertive technique?

DEFUSING

7. A nurse charts "Verbalizes understanding of the side effects of Prozac." This is an example of which category of focused charting?

Response

6. A single, pregnant teenager in a parenting class discloses her ambivalence toward the pregnancy and the subsequent guilt that these thoughts generate. A mother of three admits to having felt that way herself. Which of Yalom's curative group factors does this illustrate?

Universality

21. Which of the following are behavioral components of assertive communication?

listening