Mental health
A 6-year-old child is diagnosed with type 1 diabetes. Considering the child's cognitive developmental level, which explanation of the illness is most appropriate? "Diabetes is caused by not having any insulin in your body." "Diabetes will require you to take insulin shots for the rest of your life." "You will be taught how to give yourself insulin now that you have diabetes." "Taking insulin for your diabetes is like getting new batteries for your superhero toys."
"Taking insulin for your diabetes is like getting new batteries for your superhero toys." The child is in Piaget's stage of preoperational thought, which is manifested by magical thinking; therefore, teaching should also use magical thinking.
Which approaches should a nurse use during crisis intervention? Select all that apply. 1.Active 2.Passive 3.Reflective 4.Interpretative 5.Goal-directed
1.Active 5.Goal-directed 1. The nurse should assume an active role in assessing the current situation and facilitate the interview with authority. 5. During crisis intervention the nurse should be goal-directed to assist the client with coping with the crisis
A nurse greets a client who had been experiencing delusions of persecution and auditory hallucinations by saying, "Good evening. How are you?" The client, who has been referring to himself as "man," answers, "The man is bad." Of what is this an example? 1.Dissociation 2.Transference 3.Displacement 4.Identification
1.Dissociation rational 1. Talking in the third person reflects poor ego boundaries and a dissociation from the real self.
An adult who has been in a gay relationship for 3 years arrives at the emergency department in a near panic state. The client states, "My partner just left me. I am a wreck." What should the nurse do to help the client cope with this loss? Select all that apply. 1.Identify the client's support systems. 2.Explore the client's psychotic thoughts. 3.Reinforce the client's current self-image. 4.Encourage the client to talk about the situation. 5.Suggest that the client explore personal sexual attitudes.
1.Identify the client's support systems. 4.Encourage the client to talk about the situation. A client in crisis needs to rely on available support systems for assistance; therefore, it is vital for the nurse to identify the client's support system. Talking about the situation helps the individual to put the crisis in perspective.
A client with a diagnosis of borderline personality disorder has negative feelings toward the other clients on the unit and considers them all to be "bad." Which defense was the client using when this statement was made? 1.Splitting 2.Ambivalence 3.Passive aggression 4.Reaction formation
1.Splitting Rationale: 1. Splitting is the compartmentalization of opposite-affect states and failure to integrate the positive and negative aspects of self or others.
A 17-year-old teenager is diagnosed with leukemia. Which statements by the teenager reflect Piaget's cognitive processes associated with adolescence? Select all that apply. 1. "My smoking pot probably caused the leukemia." 2. I'm going to do my best to fight this terrible disease." 3. "Now I can't go to the prom because I have this stupid illness." 4. "I know I got sick because I've been causing a lot of problems at home." 5. "This illness is serious, but with treatment I think I will have a chance to get better."
2. "I'm going to do my best to fight this terrible disease." 3. "Now I can't go to the prom because I have this stupid illness." 5. "This illness is serious, but with treatment I think I will have a chance to get better." 1. At 2 to 7 years of age children are in the preoperational stage of cognitive development. They believe that external, unrelated, concrete phenomena cause illness. 2. At 17 years of age the adolescent is in the formal operational stage of cognitive development and therefore is able to understand the seriousness of leukemia. 3. At 17 years of age the adolescent is in the formal operational stage of cognitive development and therefore understands the seriousness of the illness. The statement also reflects an adolescent's preoccupation with peer socialization. 4. At 7 to 10 years of age children are in the concrete operational stage of cognitive development. Because of their egocentrism, they believe that they are responsible for situations, such as illnesses, and are being punished. 5. At 17 years of age the adolescent is in the formal operational stage of cognitive development and therefore is able to comprehend the seriousness of leukemia and the need for treatment.
An extremely anxious client enters a crisis center and asks a nurse for help. Which response best reflects the nurse's role in crisis intervention? 1. "Tell me what you have done to help yourself." 2."I will be here for you to help you figure things out." 3."I understand that in the past you have had problems." 4."Tell me about the things that are bothering you the most."
2."I will be here for you to help you figure things out." Clients in crisis need assistance with coping; the nurse must be involved with problem solving.
A nurse is working with a married woman who has come to the emergency department several times with injuries that appear to be related to domestic violence. While talking with the nurse manager, a nurse expresses disgust that the woman returns to the same situation. What is the nurse manager's best response? 1."She must not have the financial resources to leave her husband." 2."Most woman attempt to leave about six times before they are able to do so." 3."There is nothing the staff can do because people are free to choose their own life." 4."These women should be told how foolish they are to remain in their current situation."
2."Most woman attempt to leave about six times before they are able to do so." Nurses who work with clients who are victims of partner abuse need to be supportive and patient. It takes time and several attempts for most victims to be able to leave abusive relationships.
Among members of the nursing team, which functions are registered nurses legally permitted to perform in a mental health hospital? Select all that apply. 1.Psychotherapy 2.Health promotion 3.Case management 4.Prescribing medication 5.Treating human responses
2.Health promotion 3.Case management 5.Treating human responses
Incidents of child molestation often are revealed years later when the victim is an adult. Which defense mechanism reflects this situation? 1.Isolation 2.Repression 3.Regression 4.Introjection
2.Repression Rationale: 2. Repression is a coping mechanism in which unacceptable feelings are kept out of conscious awareness; later, under stress or anxiety, thoughts or feelings surface and come into one's conscious awareness.
A nurse reminds a client that it is time for group therapy. The client responds by yelling at the nurse, "You are always telling me what to do, just like my father!" What defense mechanism is the client using? 1.Regression 2.Transference 3.Reaction formation 4.Cognitive distortion
2.Transference With transference a client assigns to someone the feelings and attitudes originally associated with an important significant other.
In response to a question posed during a group meeting, the nurse explains that the superego is that part of the self that says: 1. "I like what I want." 2. "I want what I want." 3. "I should not want that." 4. "I can wait for what I want."
3. "I should not want that." Rational Conscience and a sense of right and wrong are expressed in the superego, which acts to counterbalance the id's desire for immediate gratification.
A nurse leads an assertiveness training program for a group of clients. Which client statement demonstrates that the treatment has been effective? 1. "I know I should put the needs of others before mine." 2. "I won't stand for it, so I told my boss he's a jerk and to get off my back." 3. "It annoys me when people call me 'Dearie,' so I told him not to do it anymore." 4. "It is easier for me to agree up front and then just do enough so that no one notices."
3. "It annoys me when people call me 'Dearie,' so I told him not to do it anymore." This is an assertive statement; it clearly states what the problem is and sets limits on undesired behavior without being demeaning.
A family member brings a relative to the local community hospital because the relative "has been acting strange." Which statements meet involuntary hospitalization criteria? Select all that apply. 1."I cry all the time, I am so sad." 2."Since I retired I have been so depressed." 3."I would like to end it all with sleeping pills." 4."Voices say it is okay for me to kill all prostitutes." 5."My boss makes me so angry by always picking on me."
3."I would like to end it all with sleeping pills." 4."Voices say it is okay for me to kill all prostitutes." Rationale: 3. This statement indicates a suicide threat; it is a direct expression of intent but without action. 4. The threat to harm others must be heeded; the client must be protected from self harm as well as harming others.
A nurse is interviewing an 8-year-old girl who was admitted to the pediatric unit. Which statement by the child needs to be explored? 1."Wow! This place has bright colors." 2."Is my mother allowed to visit me tonight?" 3."Those boys are so cute. I hope their room is next to mine!" 4."I am scared about being here. Can you stay with me awhile?"
3."Those boys are so cute. I hope their room is next to mine!" 3. A 7-year-old child should be more concerned with same-gender relationships. A child demonstrating a strong attraction to opposite-gender relations should be questioned further regarding the possibility of sexual abuse.
A client is scheduled for several diagnostic studies. Which behavior best indicates to the nurse that the client has received adequate preparation? 1.Requests that the tests be reexplained 2.Checks the appointment card repeatedly 3.Arrives early and waits quietly to be called for the tests 4.Paces up and down the hallway the morning of the tests
3.Arrives early and waits quietly to be called for the tests Rationale: 3. The client's early arrival indicates an expected degree of anxiety; the quiet waiting indicates that the client has been told what to expect.
A nurse is teaching a class about child abuse. What defense mechanism most often used by the physically abusive individual should the nurse include? 1.Repression 2.Transference 3.Manipulation 4.Displacement
4. Displacement is a defense mechanism in which one's pent-up feelings toward a threatening person are discharged on less-threatening others.
A client with diabetes mellitus is able to discuss in detail the diabetic metabolic process while eating a piece of chocolate cake. What defense mechanism does the nurse identify when evaluating this behavior? 1. Projection 2. Dissociation 3. Displacement 4. Intellectualization
4. Intellectualization Rationale: 4. Intellectualization occurs when a painful emotion is avoided by means of a rational explanation that removes the event from any personal significance.
A physician is admitted to the psychiatric unit of a community hospital. The client, who was restless, loud, aggressive, and resistive during the admission procedure, states, "I will take my own blood pressure." What is the nurse's most therapeutic response? 1."Right now you are just another client." 2."If you would rather, I'm sure you will do it correctly." 3."I will get the attendants to assist me if you do not cooperate." 4."I am sorry, but I cannot allow that because I must take your blood pressure."
4."I am sorry, but I cannot allow that because I must take your blood pressure."
A parent of a 13-year-old adolescent who was recently diagnosed with Hodgkin disease tells a nurse, "I don't want my child to know the diagnosis." How should the nurse respond? 1."It is best if your child knows the diagnosis." 2."Did you know the cure rate for Hodgkin is high?" 3."Would you like someone with Hodgkin to talk with you?" 4."Let's talk about your feeling regarding your child's diagnosis."
4."Let's talk about your feeling regarding your child's diagnosis."
As depression begins to lift, a client is asked to join a small discussion group that meets every evening on the unit. The client is reluctant to join because "I have nothing to talk about." What is the best response by the nurse? 1."Maybe tomorrow you will feel more like talking." 2."Could you start off by talking about your family?" 3."A person like you has a great deal to offer the group." 4."You feel you will not be accepted unless you have something to say?"
4."You feel you will not be accepted unless you have something to say?" This reflective statement allows the client to either validate or correct the nurse.
A client states, "I get down on myself when I make a mistake." When a cognitive therapy approach is used, which nursing interventions are most appropriate? Select all that apply. 1.Teaching the client relaxation exercises to diminish stress 2.Exploring with the client past experiences that caused distress 3.Providing the client with mastery experiences to boost self-esteem 4.Encouraging the client to replace negative thoughts with positive thoughts 5.Helping the client to modify the belief that anything less than perfection is unacceptable
4.Encouraging the client to replace negative thoughts with positive thoughts 5.Helping the client to modify the belief that anything less than perfection is unacceptable Rationale: 4. Cognitive therapy seeks to find underlying self-defeating beliefs and replace them with more reality-based positive beliefs. 5. Cognitive therapy encourages the use of cognitive restructuring (cognitive reframing) through positive self-talk and rational mindset.
What is the most important information a nurse should teach to prevent relapse in a client with a psychiatric illness? 1.Develop close support systems 2.Create a stress-free environment 3.Refrain from activities that cause anxiety 4.Follow the prescribed medication regimen
4.Follow the prescribed medication regimen This is important because side effects and denial of illness may cause clients to stop taking their medications; this is a common cause of relapse.
A male college student who is smaller than average and unable to participate in sports becomes the life of the party and a stylish dresser. What defense mechanism should the nurse determine that the client is using? Introjection Sublimation Compensation Reaction formation
Compensation
