mental health exam 1 review

Which must be addressed to establish a trusting working relationship before proceeding with the assessment?

Client's feelings and perceptions Rationale: The nurse must address the client's feelings and perceptions to establish a trusting working relationship before proceeding with the assessment.

According to Purnell's model of cultural competence, which would not be included as a primary cultural characteristic?

Occupation Rationale: Primary characteristics include age, nationality, race, color, gender, and religion. Secondary characteristics include educational and socioeconomic status, occupation, military status, political beliefs, and residential status.

When initiating an assessment, the nurse should use which type of questioning?

Open-ended questions Rationale: The nurse should use open-ended questions when gathering assessment data from the client. Doing so allows the client to begin as he or she feels comfortable and also gives the nurse an idea about the client's perception of his or her situation.

which elements are essential in a clinician's duty to warn?

A) client makes threatening C) potential victims are identifiable F) threat of harm is serious

confidentiality means respecting the client's right to keep his or her information private. When can the nurse information about the client?

A)The client threatens to harm a family member C)The client gives written permission. D) The client's legal guardian asks for information

A nurse is preparing a presentation for a group of staff nurses on anger. When describing maladaptive anger, which psychiatric condition would the nurse identify as being linked to this anger?

Depression Rationale: Maladaptive anger (excessive outwardly directed anger or suppressed anger) is linked to psychiatric conditions, such as depression, as well as a plethora of medical conditions.

When a client talks about the recent loss of a family member while laughing or smiling, this type of affect would be labeled as what?

Inappropriate Rationale: An inappropriate affect is displaying a facial expression that is incongruent with the mood or situation. A blunted affect is showing little or a slow-to-respond facial expression. A restricted affect is displaying one type of expression, usually serious or somber. A flat affect is exhibited by no facial expression.

Which statement by the nurse demonstrates an understanding of the first step in helping a client learn the problem solving process?

"Can you explain to me what made you so angry?" Rationale: Identifying the problem (trigger for the anger) is the initial step in the problem solving process followed by brainstorming all possible solutions (different ways to manage the anger). Selecting the best alternative, implementing the selected alternation, and then evaluating the situation are the remaining steps in the process.

Abstract standards that provide a person with his or her code of conduct are

values

which is an example of an open-ended question?

what concerns you most about your health?

which is an example of a closed-ended question?

where are you employed?

Which intervention does not meet the standard of care for the client in seclusion?

Documented assessment by the nurse every 3 to 4 hours Rationale: Documented assessment should take place by the nurse every 1 to 2 hours with close supervision of the client

Increased activity in which neurotransmitter is implicated in increased impulsivity and violent behavior?

Dopamine Rationale: Increased activity of dopamine is implicated in increased impulsivity and violent behavior as a result of changes in cognition and decreased emotional regulation.

moral treatment of the mentally ill

Dorothea Dix

asylym as a safe refuge

Philippe Pinel/ william dukes

The delivery of culturally competent nursing care requires the incorporation of which concept?

Planning and implementing care that is sensitive to the needs of clients from diverse cultures. Rationale: Providing culturally competent nursing care means that care is planned and implemented in a way that is sensitive to the needs of individuals, families, and groups from diverse cultural populations within society. To provide culturally competent care, the nurse must be aware that the health care system itself is a culture and that cultural imposition and ethnocentrism must be avoided.

The nurse is providing care for a recent immigrant from India. When the client identifies as a member of the culture's lowest caste, what concern should the nurse address first with the client?

That medical and psychiatric care in the U.S. are not dependent on social status Rationale: The nurse must determine whether social class is a factor in how clients relate to health care providers and the health care system. In many countries, social class is a powerful influence on social relationships and can determine how people relate to one another, even in a health care setting. For example, the caste system still exists in India, and people in the lowest caste may feel unworthy or undeserving of the same level of health care as people in higher castes. None of the remaining options address this issue of seeking and accepting health care services.

A 22-year-old client has voluntarily sought treatment for an eating disorder at a rural residential facility. Despite a promising start, the client has been involved in recent conflicts with staff members and insists that the client wants to leave the facility. Staff members have refused to facilitate the client's transportation from the facility and have stated that they will not return the client's money and identification that were held when the client was admitted. Staff at the treatment facility may be guilty of false imprisonment due to what?

The client voluntarily admitted for treatment. Rationale: False imprisonment is the intentional and unjustifiable detention of a person against his or her will. The client voluntarily sought treatment and is not a physical threat to the self or others. The client's prognosis and the location of facility are not among the criteria for false imprisonment. Eating disorders are psychiatric illnesses.

Which would be the least optimal environment for therapeutic communication for a client who has difficulty maintaining boundaries?

The client's room Rationale: If the client is unable to maintain boundaries by expressing inappropriate conversation or physical actions, a more formal or public setting such as an interview room, conference room, or at the end of the hall would be a more appropriate place to maintain therapeutic communication.

Which phase of the aggression cycle is defined as occurring when an event or circumstance in the environment initiates the client's response?

Triggering Rationale: During the triggering phase of the aggression cycle, an event or circumstance in the environment initiates the client's response, which is often anger or hostility. None of the other phases of the cycle are focused on the initiation of the anger.

A psychiatric-mental health nurse is teaching a class for a group of colleagues about anger, aggression, and violence. Which statement by the nurse would be most appropriate to include?

Women often supress their feelings of anger." Rationale: Societal constraints often inhibit women's expression of their anger; they have been socialized to maintain and enhance relationships with others and avoid expressing so-called negative or unfeminine emotions such as anger. Anger, aggression, and violence should not be viewed as a continuum because one does not necessarily lead to another. Language related to anger is imprecise and confusing. People can choose to slow down their reactions and to think and behave differently in response to events; therefore, anger is not a knee-jerk reaction to external events.

The nurse asks the client to explain the meaning of the proverb "a stitch in time saves nine." Which explanation given by the client indicates concrete thinking?

You should not forget to sew up holes in your clothes. Rationale: When a client always gives a literal translation of a comment or situation, it indicates that the client uses concrete thinking. The literal translation of the proverb "a stitch in time saves nine" is that "you should not forget to sew up holes in your clothes." Thus, this statement of the client indicates concrete thinking. The statement "one should always stitch before nine o'clock" indicates that the client has not even understood the literal meaning of the proverb. As for "fixing things on time would prevent bigger problems in future" and "If you solve one problem, you will prevent nine problems in future," both are correct explanations of the proverb. If the client gives these explanations, then the client uses abstract thinking.

which would indicate a duty to warn a third party?

a client states " if i can't have my girlfriend back, then no one can have her."

"Earlier today you said you were concerned that your son was still upset with you. When i stopped by your room about an hour ago, you and your son seemed relaxed and smiling as you spoke to each other. How did things go between the two of you?"

consensual validation

which is the most influential in determining health beliefs and practices?

cultural factors

Which client behavior would the nurse document as being an automatism?

drumming one's fingers on the table top Rationale: An automatism is a repeated purposeless behaviors often indicative of anxiety, such as drumming fingers, twisting locks of hair, or tapping the foot. None of the other options are generally associated with an expression of anxiety.

which assessment indicates positive growth and development for a 30- year-old adult

enjoys social activites with three or four close friends

assessment data about the client's speech patterns are categorized in which of the following area?

general appearence and motor behavior

Which nursing intervention demonstrates congruence in a therapeutic nurse-client relationship?

getting an appointment with the client at the time previously agreed upon Rationale: Congruence occurs when words and actions match. The nurse demonstrates this by fulfilling the promise made to the client. While the remaining options are appropriate behaviors that positively affect the nurse-client relationship, they do not demonstrate congruence.

the clients belief that a news broadcast has special meaning for him or her is an example of

ideas of reference

which states the naturalistic view of what causes illness?

illness is caused by cold, heat, wind, and dampness

"How does jerry make you upset?" is a nontherapeutic communication technique because it

indicates an external source of the emotion

Hildegard Peplau is best known for her writing about

therapeutic nurse- client relationship

Which represents the best brief definition of culture?

*Culture is shared attitudes, customs, and beliefs. Rationale: Members of groups share an accepted way of life that provides a general structure for living, as well as patterns by which they interpret reality. The structure includes all of the socially learned behaviors, values, beliefs, customs and ways of thinking of a population that guide its members' views of themselves and the world.

All except which problem stem from attitudes in which the focus is on the nurse's beliefs and values rather than those of the client?

*Treating the client as a source of cultural information Rationale: Treating the client as a source of cultural information aligns with culturally competent nursing care. The nurse conveys that the client has individual preferences and beliefs even if he or she is part of a specific cultural group. Holding a preconceived judgement about cultural groups is consistent with the conveyance of prejudice. The development of general beliefs about all people from the same culture conveys stereotyping. Viewing a specific client population from stigmatized view is promoting stigma or disapproval.

The nurse is performing a psychosocial assessment of a client. Which questions should the nurse ask to assess the client's self-concept? Select all that apply.

-"How do you think you look today?" -"What do you do when you have a problem?" Rationale: Self-concept is the way one views oneself. It includes perception of body image, coping skills, social image, and academic and occupational image. By asking "how do you think you look today," the nurse is trying to understand the client's body image. By asking "what do you do when you have a problem," the nurse is trying to understand the client's method of coping with problems. Thus, these questions indicate that the nurse is assessing the self-concept of the client. By asking "which country do you live in," the nurse is assessing the memory of the client. By asking "are you thinking about killing yourself," the nurse is assessing if the client has suicidal ideation. By asking "what time is it," the nurse is assessing the client's orientation.

The nurse is performing a psychosocial assessment of a client with a mental illness. What information should the nurse gather from the client while taking the history? Select all that apply.

-Cultural considerations -Chronological age -Spiritual beliefs Rationale: In a psychosocial assessment, the history should include the client's age and their cultural and spiritual beliefs. The eating habits of the client are a part of the physiologic and self-care considerations during the assessment. The support systems of the client are assessed in the roles and relationships part of the assessment.

A psychiatric-mental health nurse is engaging in active listening with a client. Which technique would the nurse most likely use? Select all that apply.

-Responding indirectly to statements -Using open-ended statements -Concentrating fully on what the client says Rationale: Through active listening, the nurse focuses on what the client is saying to interpret and respond objectively to the message. While listening, the nurse concentrates only on what the client is saying and on the underlying meaning. The nurse usually responds indirectly, using techniques such as open-ended statements, reflection, and questions that elicit additional responses from the client. Changing the subject is avoided. Allowing the client to talk as the client wishes reflects passive listening, which does not foster a therapeutic relationship.

What percentage of adults requiring mental health services get the care they need?

25% Rationale: Only about 25%, or 1 in 4, of adults requiring mental health services get the care that they need.

The therapeutic communication interaction is most comfortable when the nurse and the client are how far apart?

3 to 6 feet Rationale: The therapeutic communication interaction is most comfortable when the nurse is 3 to 6 feet away from the client.

Which type of hallucination is the most common?

Auditory Rationale: Auditory hallucinations are the most common. Visual hallucinations are the second most common.

Which therapeutic communication technique is being utilized when the nurse asks the client, "Is there something you'd like to talk about?"

Broad opening Rationale: This is an example of a broad opening, which allows the client to take the initiative in introducing the topic. Accepting is indicating reception. Exploring is delving further into a subject or idea. Focusing is concentrating on a single point.

Which type of cue is being used when the client states, "Nothing can help me"?

Covert Rationale: Cues are considered to be either covert or overt. Covert cues are vague or hidden messages that need interpretation and exploration. Overt cues are clear statements of intent, such as "I want to die."

Which developmental task occurs in the middle adult growth area?

Creation of a comfortable home Rationale: Creation of a comfortable home is a task that occurs as a developmental task in middle adulthood. In the older adult stage, preparation for retirement and maintenance of a maximal level of health occurs, along with adjustment to health changes.

When determining the existence of malpractice, which factor is not considered?

Intent Rationale: Malpractice must be proven by duty, breach of duty, injury or damage, and causation. Intention is not a factor that is considered.

firtst american psychiatric nurse

Linda Richards

Which drug has been effective in treating aggressive clients diagnosed with bipolar disorders?

Lithium Rationale: Lithium, an antimanic medication, has been effective in treating aggressive clients with bipolar disorder.

managed care is designed to

Maintain a balance between the quality and costs of health care

Which would not be considered a goal of therapeutic communication?

Self-exploration of feelings by the nurse Rationale: Self-exploration of feelings by the nurse is not considered a goal of therapeutic communication. Establishing rapport, active listening, and guiding the client in problem solving are goals of therapeutic communication.

Which is an inaccurate depiction of concrete messaging?

They require rephrasing of unclear messaging. Rationale: Concrete messages do not require rephrasing of unclear messages. They elicit more accurate responses. They are easy to understand, and there is no need for interpretation.

which statement about anger is true?

anger result from being frustrated, hurt, or afraid

The emotional frame of reference by which one sees the world is created by

attitudes

Client: I was so upset about my sister ignoring my pain when I broke my leg. Nurse: When are you going to your next diabetes education program? This is a nontherapeutic response because the nurse has:

changed the topic

Ideas that one holds as true are

beliefs

which type of drugs require cautious use when potentially aggressive clients?

benzodiazepiners

the nurse observes a client muttering to himself and pounding his fist in his other hand while pacing in the hallway. Which principle should guide the nurses actions

clients who can verbalize angry feelings are less likely to become physically aggressive

"Why do you always complain about the night nurse? she is a nice woman and a fine nurse and has five kids to support. you're wrong when you say she is noisy and uncaring."

defending

the client who believes everyone is out o get him or her is experiencing

delusion

when the nurse is assessing whether the client's ideas are logical and make sense the nurse is examining which of the following areas?

thought process

mental health parity laws ensure

Equality in insurance coverage for mental illness

A client is pacing in the hallway with clenched fists and a flushed face. He is yelling and swearing. Which phase of the aggression cycle is he in?

Escaltion

Client "I had an accident" Nurse "Tell me about your accident" this is an example of which therapeutic communication technique?

General lead

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." Rationale: The correct response by the nurse demonstrates the ability to use the self as a therapeutic tool in order to help the client grow, change, and heal. Telling the client that being self-sufficient is a sign of mental health stability is an automatic response and would cut off further exploring of the client's perceptions. Telling the client the family would want to help when there is a problem is making an assumption without first discussing the client's perceptions. Asking the client how the client plans to manage problems without help communicates sympathy and the need for dependency.

Which of the nurse's assessment questions would best identify whether the client has insight into the illness?

"Do you think that your illness prevents you from functioning well, and if so, how?" Rationale: Insight is defined as self-understanding about the origin, nature, and mechanisms of one's attitudes and behavior; it can often be ascertained by asking whether the client believes oneself to be in need of treatment and how the client perceives oneself to have limitations in function as a result of the illness. Asking the client if anyone has ever spoken to the client in the past about having a mental illness does not provide information about the client's insight, but it can assess the client's memory. Asking the client if "anything like this has" happened to the client before assesses the client's memory. Asking the client if the client hears voices that others do not hear assesses for the presence of auditory hallucinations.

A person brings a parent to the clinic and tells the nurse that the parent has begun to act strangely in the past few days, with unprovoked outbursts of anger. After the incidents, the parent expresses remorse for the outburst. The person says, "I've never seen my parent act this way." Which question would be most appropriate for the nurse to ask next?

"Has your parent suffered any traumatic injury to the brain recently?" Rationale: Asking about injury to the brain would be most appropriate because the limbic system and cerebral cortex are the brain structures most frequently associated with aggressive behavior. Clients with a history of damage to the cerebral cortex are more likely to exhibit increased impulsivity, decreased inhibition, and decreased judgment than are those who have not experienced such damage. Schizophrenia and substance abuse are also associated with violent behavior. Asking about previous problems with anger would be important to know but would not be the priority. Additionally, the person states that the parent has never done this before. Injury to the back of the head or neck is not associated with aggression.

which of the following is a concrete message

"Help me put this pile of books on Marsha's desk"

which is an example of assertive communication

"I feel angry when you walk away when im talking."

Which statement by the client best demonstrates a healthy relationship with family?

"I feel better after I visit with my Mom." Rationale: The relationship with others is important to mental health. Feeling better after having contact with a particular person demonstrates a healthy relationship. While all the options present positive statements, only the correct option is obviously positive in the result of the interaction.

which client statement would indicate self- efficacy

"I know if i can learn to relax. I will feel better."

Which statement by the nurse is an example of assertive communication?

"I understand that group can be difficult to attend but coming late is disruptive." Rationale: Assertive communication is the ability to express positive and negative ideas and feelings in an open, honest, and direct way. It recognizes the rights of both parties. Losing one's temper is an example of aggressive communication. The other options demonstrate passive-aggressive and passive communication.

which statement would cause concern for achievement of development tasks of a 55-year-old woman

"My children need me now just as much as when they were younger"

Which statement by the nurse demonstrates acceptance to the client who has made a sexually inappropriate comment?

"Our relationship is one of a professional nature." Rationale: The nurse who does not become upset or responds negatively to a client's outbursts, anger, or acting out conveys acceptance to the client. Avoiding judgments of the person, no matter what the behavior, is acceptance. This does not mean acceptance of inappropriate behavior but acceptance of the person as worthy. When responding to such a situation, the reaction should be respectful and controlled by the nurse.

A psychiatric-mental health nurse is assessing a client. Which statement by a client would the nurse recognize as evidence of an absence of insight?

"Sometimes I feel like the world would be better off if I were dead." Rationale: Insight is characterized as an awareness of one's circumstances; it includes awareness of thoughts, feelings, and behaviors and ability in relation to the thoughts, feelings, and behaviors of others. Presuming that all people feel the world would benefit from their absence suggests a lack of insight. Anger at the perceived incompetence of care providers, apathy about one's bleak future, and expressions of despondency certainly warrant further assessment and treatment, but they do not necessarily indicate a lack of insight.

when the client says "I met joe at the dance last week," what is the best way for the nurse to ask the client to describe her relationship with joe

"Tell me about you and Joe"

Which statement would indicate that the nurse has a non-judgmental attitude?

"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." Rationale: The statement about the client who is trying to make the individual changes necessary is void of personal opinion and value judgments. It is a neutral statement of client data.

Which statement made by the client demonstrates hardiness when faced with a health issue?

"What do I need to do to manage this illness?" Rationale: Personal hardiness is often described as a pattern of attitudes and actions that helps the person turn stressful circumstances into opportunities for growth. Persons with high hardiness perceive stressors more accurately and are able to problem solve in the situation more effectively. None of the other options demonstrates this problem-solving characteristic.

An adult client is pacing and yelling. Which is the best response by the nurse?

"When did these feelings begin?" Rationale: When a client is angry, use open-ended questions to clarify the client's behavior. Use an empathetic approach to assist the client to discover the source of the anger. Asking a "why" question implies criticism of the feeling. The client may become defensive and angrier. Similarly asking, "What are you doing?" asks the client to explain behavior when the client may not be fully aware of the source. The question also implies criticism rather than offering empathy. Asking, "With whom are you angry," is a closed-ended question that will not open the thinking and dialogue with the client. Further, asking about the object of the anger focuses on an external reason for the anger rather than assisting the client to look within for the source.

Which client statement indicates the most insight into his or her issue with auditory hallucinations?

*"The voices aren't real but it's hard to ignore them." Rationale: Initially, clients perceive hallucinations as real experiences, but later in the illness, they may recognize them as hallucinations. Insight is the ability to understand the true nature of one's situation and accept some personal responsibility for that situation. The correct option is the only one that demonstrates these abilities.

A nurse who provides care in a large, city hospital is aware of the large influence of culture on health. The nurse recognizes that culture is best understood as a shared system that encompasses what?

*Beliefs, values, and behavioral traditions Rationale: Culture is defined in many ways, but at the broadest level, it can be understood to be a shared system of beliefs, values, and behavioral expectations that provide social structure for daily living. These beliefs, values, and expectations frequently direct other aspects of an individual's life such as thinking, behavior, dress, and diet, but these are not the central components of the concept of culture.

Which question should be avoided because it may be perceived as criticism by the client?

*Why? Rationale: Asking "why" questions may be perceived as criticism by the client, conveying a negative judgment from the nurse.

The nurse is teaching effective anger management. The nurse emphasizes the use of assertive sentences while expressing anger. Which are examples of assertive communication? Select all that apply.

-"I am frustrated with the situation. -"I am feeling disrespected by your comments." Rationale: Expression of anger using assertive communication refers to the use of statements beginning with 'I' while expressing anger. Statements such as "I am frustrated with this situation" and "I am feeling disrespected by your comments" are examples of assertive communication. Statements such as "You are making me very angry," "How dare you not listen to me," and "How can you behave like this with me?" are not examples of assertive communication as they communicate accusation, blame, and use "you" rather than "I" in the statement.

The nurse is teaching a group of clients in a juvenile detention center about anger management and the positive effects of anger, if handled appropriately. What advantages, as explained by the nurse, may be helpful to the clients? Select all that apply.

-Anger helps to focus attention. -Anger helps in decision making. -Anger helps in resolving conflicts. Rationale: Anger can help a person to solve problems and make decisions, if handled appropriately. Anger also energizes the body physically by activating the fight or flight response, which helps the person focus their attention on the stressor. When handled inappropriately, anger can cause physical and emotional problems and, as such, does not improve emotional stability or help in increasing relaxation.

A psychiatric-mental health nurse is working with several clients and decides to use silence during the interaction. In which situation would it be therapeutically appropriate to use silence? Select all that apply.

-Client who is experiencing depression -Client who is lost in own thoughts -Client who is constructing a response -Client who is pondering the question Rationale: Silence, or long pauses, in communication may indicate many different things. The client may be depressed and struggling to find the energy to talk. Sometimes, pauses indicate the client is thoughtfully considering the question before responding. At times, the client may seem to be "lost in his or her own thoughts." It is important to allow the client sufficient time to respond, even if it seems like a long time. Being resistant or unwilling to participate in the conversation is not acceptable and must be addressed by the nurse directly rather than by using silence.

An aggressive client gets hold of a glass piece and prevents anyone from entering the room. What interventions should the nurse perform to ensure safety of the client, staff, and other clients? Select all that apply.

-Summon help from others -Leave the area immediately -Shift other clients to a safe place Rationale: The aggressive client with a potentially harmful weapon in hand can be dangerous to self, staff, and other clients. The nurse should summon help to help control the client. The nurse should leave the area immediately if unable to calm the client and the situation is an emergent one. The other clients should be shifted to another area to ensure safety. Attempting to remove the weapon from the client may increase the risk of injury to the nurse. The client may not be able to understand the instructions; therefore, taking down the client may not be helpful.

Which tools would a nurse use to objectively assess a client's personality? Select all that apply

-Tennessee Self-Concept Scale (TSCS) -Milton Clinical Multiaxial Inventory (MCMI) -Psychological Screening Inventory (PSI) Rationale: The Tennessee Self-Concept Scale (TSCS), the Milton Clinical Multiaxial Inventory (MCMI), and the Psychological Screening Inventory (PSI) are designed as objective measures of personality in which the nurse compares the client's answers with standard answers or criteria and obtains a score or scores. The thematic apperception test (TAT) and the Rorschach test are projective measures of personality; these are unstructured and are usually conducted by the interview method.

The nurse is explaining the importance of expressing anger to a client. What should the nurse mention as the possible physical complications associated with suppressing anger? Select all that apply.

-Ulcers -Coronary artery disease -Migraine headaches Rationale: Suppressing rage or anger could lead to physical complications such as ulcers, coronary artery disease, and migraine headaches. Depression and low self-esteem are emotional problems associated with suppression of anger.

the advantages of assertive communication are

A) all person's rights are respected C)it protects the speaker from being exploited D) the speaker can say no to another person's request E) the speaker can safely express thoughts and feelings

which elements are necessary to prove liability in a malpractice lawsuit

A) client is injured B) failure to conform to standards of care C) injury caused by breach of duty F) recognized relationship between client and nurse

When the nurse asks, "How would you carry out this plan?" the nurse is questioning which component of a suicide assessment?

Access Rationale: A question with regard to suicide assessment and access would include "How would you carry out this plan?"

Which role of the nurse-client relationship is being exhibited when the nurse informs the client and then supports the client in whatever decision the client makes?

Advocate Rationale: In the advocate role, the nurse informs the client and then supports the client in whatever decision the client makes. The primary caregiving role in mental health settings is the implementation of the therapeutic relationship to build trust and explore feelings. In the teacher role, the nurse instructs the client about the client's medication regimen. In the role of the parent surrogate, the nurse may be tempted to assume a parental role.

When communicating with a client in the triggering phase of the aggression cycle, which intervention should the nurse include?

Allow the client to take a "time out" in a quiet area Rationale: During the triggering phase, the nurse should approach the client in a nonthreatening, calm manner in order to deescalate the client's emotion and behavior. The nurse can suggest that the client go to a quiet area or may get assistance to move other clients to decrease stimulation.

Which describes a strong emotional response to a real or perceived provocation?

Anger Rationale: Anger is a strong, uncomfortable, emotional response to a real or perceived provocation. Physical aggression is behavior in which a person attacks or injures another person or that involves destruction of property. Catharsis includes activities that provide a release of the anger. Hostility is an emotion expressed through verbal abuse, lack of cooperation, violation of rules or norms, or threatening behavior.

High-pitched, rapid delivery of a message often indicates what?

Anxiety Rationale: High-pitched, rapid delivery of a message often indicates anxiety.

The nurse who is preparing a Native American client for surgery notes that the client is wearing a medicine bag. What intervention should the nurse implement to best address the client's spiritual needs with respect to presurgical care needs?

Ask the client how the medicine bag can be respected while preparing for surgery. Rationale: Nurses who are unsure of a person's social or cultural preferences need to ask the client directly during the initial encounter about preferred terms of address and ways the nurse can help support the client's spiritual, religious, or health practices. None of the remaining options demonstrates respect and interest in the client's spiritual needs related to the medicine bag.

Which is not considered a step in the values clarification process?

Assessing Rationale: Assessing is not a step in the values clarification process. Choosing is when the person considers a range of possibilities and freely chooses the values that feel right. Prizing is when the person considered the value, cherishes it, and publicly attaches it to himself or herself. Acting is when the person puts the values into action.

A client is being admitted to an inpatient setting. It is important for the nurse to first obtain which information about the client?

Assessment of history Rationale: When the client is being admitted to inpatient setting, the nurse first obtains the client's psychiatric history. In the inpatient setting, a thorough psychiatric history would be more important to address early, rather than educational level, social status, and insurance information.

Hospitals established by Dorothea Dix were designed to provide which of the following?

Asylum

A client was admitted for electroconvulsive therapy (ECT). The physician performing the procedure failed to obtain informed consent before the ECT was administered. The physician could be charged with what?

Battery Rationale: All clients have the right to give informed consent before health care professionals perform interventions. Administration of treatments or procedures without a client's informed consent can result in legal action against the primary provider and the health care agency. In such lawsuits, clients will prevail, alleging battery (touching another without permission), if they can prove they did not consent to the procedure, providers did not give adequate information for a decision, or the treatment exceeded the scope of the consent.

which are specific tasks of the working phase of a therapeutic relationship?

C) encourage expression of feeling E) facilitate behavior change F)promote self-esteem

Which term is used to describe an activity used to release anger?

Catharsis Rationale: Catharsis includes activities that provide a release of the anger. Hostility is an emotion expressed through verbal abuse, lack of cooperation, violation of rules or norms, or threatening behavior. Anger is a strong, uncomfortable, emotional response to a real or perceived provocation. Physical aggression is behavior in which a person attacks or injures another person or that involves destruction of property.

The nurse is preparing a psychosocial assessment for use with clients with various mental health conditions. For which group of clients should the nurse include mostly closed-ended questions?

Clients with adult attention deficit hyperactivity disorder Rationale: Clients with attention deficit hyperactivity disorder have reduced attention span, which in turn causes disorganization in their thought processes. These clients may be unable to answer open-ended questions that require a detailed explanation. Thus, the nurse should try to include the maximum number of closed-ended questions in the assessment. Disordered thought is not commonly seen in depression, post-traumatic stress disorder, or antisocial personality disorder. More open-ended questions should be asked of these clients in order to understand their perception of their illness.

Asking the client to complete serial sevens assesses what?

Concentration Rationale: Asking the client to complete serial sevens is assessing the client's ability to concentrate. Orientation refers to the client's recognition of person, place, and time. Judgment refers to the ability to interpret one's environment and situation correctly and to adapt one's behavior and decisions accordingly. Insight is the ability to understand the true nature of one's situation and accept some personal responsibility for that situation.

Which includes the circumstances or parts that clarify the meaning of the content of the message?

Context Rationale: Context includes the circumstances or parts that clarify the meaning of the content of the message. Process denotes all nonverbal messages that the speaker uses to give meaning and content to the message. Congruence occurs when the process and content agree. Proxemics is the study of distance zones between people during communication.

Which component of hardiness encompasses the ability to make appropriate decisions in life activities?

Control Rationale: Control is the ability to make appropriate decisions in life activities. Commitment is active involvement in life activities. Challenge is the ability to perceive change as beneficial rather than just stressful. Change is not a component of hardiness, according to Kobasa (1979).

In which phase of the aggression cycle can techniques of seclusion or restraint be used to deal with the aggression quickly?

Crisis Rationale: In the crisis phase, seclusion or restraint may be used to deal with aggression quickly.

Which term is used to refer to signals that encourage effective communication?

Cues Rationale: A cue is a verbal or nonverbal message that signals key words or issues for the client. An abstract message is an unclear pattern of words that often contains figures of speech that are difficult to interpret. In a concrete message, words are explicit and need no interpretation. A metaphor is a phrase that describes an object or situation by comparing it to something else familiar.

The nurse ensures that a Hispanic client who requests to participate in Mass is able to attend each Sunday morning in the hospital chapel. What type of behavior is the nurse exhibiting in the care of this client?

Culturally competent nursing care Rationale: Cultural competence involves incorporating cultural beliefs into health care. It encompasses skills, both academic and interpersonal, to understand and appreciate cultural differences and similarities within, between, and among groups to meet the social, cultural, and linguistic needs of an individual.

which of the following are examples of a therapeutic communication response

D) "Tell me more about your discharge plans." F.)" what might you do the next time you're feeling angry?"

A nurse is beginning the process of providing therapy to a client with anger management problems. When implementing this therapy, which should occur first to promote optimal effectiveness?

Development of a therapeutic relationship Rationale: With cognitive-behavioral therapy, the recommendation is to first establish the therapeutic alliance because some angry individuals are not in a stage of readiness to change their behavior. When clients are more receptive, cognitive-behavioral therapy involves avoidance of provoking stimuli, self-monitoring regarding cues of anger arousal, stimulus control, response disruption, and guided practice of more effective anger behaviors.

In order to help preserve and maintain a client's cultural belief regarding the need for "hot foods," which action should the culturally competent nurse take?

Educate the staff to help them assist the client in selecting food choices from the client's menu that supports this belief Rationale: In cultural care preservation/maintenance, the nurse assists the client in maintaining health practices that are derived from membership in a certain ethnic group. The nurse helps the client select and obtain foods congruent with these beliefs most effectively by educating staff. This is not necessarily possible or even advised if there are medically required food restrictions.

classification of mental disorders according to symptoms

Emil Kraepelin

What term is used to identify the situation when ethical principles conflict or when there is not one clear course of action in a given situation?

Ethical dilemma Rationale: An ethical dilemma occurs when there is a situation in which ethical principles conflict or when there is not one clear course of action in a given situation. Breach of duty occurs when the nurse or physician failed to conform to standards of care. Negligence is an unintentional tort that involves causing harm by failing to do what a reasonable and prudent person would do in similar circumstances. Malpractice is a type of negligence that refers specifically to professionals, such as nurses and physicians.

When the nurse states, "Tell me more about that," the nurse is utilizing which communication technique?

Exploring Rationale: Exploring is delving further into a subject or area. Focusing is concentrating on one simple point. Accepting is indicating reception. Formulating a plan of action is asking the client to consider kinds of behavior likely to be appropriate in future situations.

Which type of affect is represented by showing no facial expression?

Flat Rationale: A flat affect is exhibited by no facial expression. A blunted affect is showing little or a slow-to-respond facial expression. An inappropriate affect is displaying a facial expression that is incongruent with the mood or situation. A restricted affect is displaying one type of expression, usually serious or somber.

What is the therapeutic goal of seclusion?

Give the client the opportunity to gain self-control Rationale: The goal of seclusion is to give the client an opportunity to regain physical and emotional self-control. Clients are not to be punished for behaviors. The client who meets the criteria for seclusion is not in the emotional state to engage in self-reflection. Seclusion is used for the purpose of assuring client and staff safety.

therapeutic nurse-client relationship

Hildegard Peplau

Which term is used to describe an emotion expressed through verbal abuse and violation of rules or norms?

Hostility Rationale: Hostility is an emotion expressed through verbal abuse, lack of cooperation, violation of rules or norms, or threatening behavior. Anger is a strong, uncomfortable, emotional response to a real or perceived provocation. Catharsis includes activities that provide a release of the anger. Physical aggression is behavior in which a person attacks or injures another person or that involves destruction of property.

When providing care for a cognitively impaired client who is strongly tied to the client's culture of origin, the nurse supports these expectations by doing what?

Including family when discussing new medication treatment options Rationale: In many ethnic groups, individualism is not a primary value. Instead, these groups are sociocentric, emphasizing the mandatory responsibility of the individual to the family and larger society. Decisions tend to be made with input from the family not solely by the individual. Encouraging the family to consider enrolling the client in an adult day care center and providing family members with information regarding appropriate long-term care facilities are not sociocentric, since the culture would not be receptive to delegating the care of a family member to someone outside the family. Being careful to discuss the client's condition only with the client's spouse is not sociocentric since the culture would not be receptive to withholding informational discussions from family members.

Which stage of Erikson's psychosocial development includes building confidence in one's own abilities?

Industry versus inferiority Rationale: Industry versus inferiority includes building confidence in one's own abilities and taking pleasure in accomplishments. Initiative versus shame and doubt involves achieving a sense of control and free will. Identity versus role confusion involves formulating a sense of self and belonging. Generativity versus stagnation involves the task of establishing for the next generation.

Which is the most influencing factor that complicates the treatment of people with mental illness in the Unites States?

Insurers' reimbursement decisions Rationale: A goal of behavioral health managed care has been to reduce hospital admissions, which are the most expensive part of psychiatric care. Unfortunately, some managed care "gatekeepers" have denied or restricted access to needed services and therefore have added to the discouragement, distress, and even despair of clients and their families.

Which is a true statement regarding Medicaid?

It covers individuals and families with low incomes. Rationale: Medicaid covers individuals and families with low incomes. Medicare covers people 65 years of age and older, those with permanent kidney failure, and those with certain disabilities.

Which is an inaccurate statement regarding a preconception?

It enables the nurse to get an accurate picture of the client's problems. Rationale: A preconception does not enable the nurse to get an accurate picture of the client's problems. It is a way that a person expects another to behave and can prevent people from getting to know one another. It may prevent the nurse from developing a therapeutic relationship with the client.

What is the most significant benefit of using Beck's Depression Inventory to the practice of evidence-based nursing practice?

It is a standardized, reliable depression tool. Rationale: Evidence-based practice promotes the use of standardized, valid, and reliable tools, guidelines, and protocols in mental health, based on aggregate data. Tools based on the majority of the population presume similarity and stability over time. While the other options are true statements about this screening tool, none are associated with evidence based practice.

Until the onset of the Renaissance, the general population held which belief regarding the presence of sickness?

It was punishment for sins and wrongdoing. Rationale: People of ancient times believed that sickness was a punishment for sins and wrongdoing. It was not a weakness of physical strength, based on social class, or due to inadequate parenting.

When the nurse asks the client, "If you found a stamped addressed envelope on the ground, what would you do?" the nurse is assessing which component of the assessment?

Judgment Rationale: The nurse may assess a client's judgment by asking the client hypothetical questions, such as "If you found a stamped addressed envelope on the ground, what would you do?"

A client comes to the emergency department with severe depression and suicidal ideation. Staff members determine that the client does not have adequate insurance to cover inpatient psychiatric services at their facility, so they discharge the client with some prescriptions for medication. Which principle is being ignored by discharging this client?

Justice Rationale: Justice is the duty to treat all clients fairly. It can become an ethical issue in mental health when a segment of the population does not have access to care, as in this case, in which access to inpatient care is warranted but denied.

A client from which cultural background would most likely have an older family member present when discussing health issues with the nurse?

Korean Rationale: The nurse must understand the differences in how various cultures communicate. It helps to see how a person from another culture acts toward and speaks with others. Australia and many European cultures are individualistic; they value self-reliance and independence and focus on individual goals and achievements and so would be less likely to include others in the discussion. Other cultures, such as Chinese and Korean, are collectivistic, valuing the group and observing obligations that enhance the security of the group.

Medical insurance coverage for medical illnesses is greater than for psychiatric illnesses. What term best describes this discrepancy?

Lack of parity. Rationale: Parity refers to the various inequities inherent in any health care system. Many health plans cover the costs of psychotropic drugs at far lower rates than they do for other medications. Health care inequities are largely a result of social values and perceived significance. A gap exists between the most effective treatments available and what people actually receive. It is difficult for clients and families to determine what services are needed and where to find them, which causes limited access to services. Medication noncompliance occurs when clients do not take their medications as prescribed.

Racial bias is evident in mental health care treatment, as reflected by what?

Nonwhite clients are institutionalized much more frequently than are whites. Rationale: Demographic data indicate a disproportionate number of nonwhite mental heath patients in acute care services.

Which stage of psychosocial development involves establishing the next generation?

Middle adult Rationale: Middle adulthood involves the task of establishing the next generation. Adolescence involves the task of formulating a sense of self and belonging. Young adulthood involves the task of forming adult, loving relationships and meaningful attachment to others. Maturity involves the task of accepting responsibility for oneself and life.

Maintaining a therapeutic environment and promoting growth through role modeling are components of which basic level function?

Milieu therapy Rationale: A basic level function is milieu therapy, which is the maintenance of the therapeutic environment. Counseling involves interventions and communication. Health teaching is a basic level function, as is case management.

In which phase of the aggression cycle is the client removed from restraint or seclusion as soon as he or she meets the behavioral criteria?

Postcrisis Rationale: In the postcrisis phase, the client is removed from restraint or seclusion as soon as he or she meets the behavioral criteria. The client would not be able to demonstrate control in any of the other phases.

Which mental health service is an advanced-level function?

Psychotherapy Rationale: Psychotherapy is an advanced-level function. Milieu therapy, counseling, and self-care activities are basic level functions.

During which phase of the aggression cycle does the client regain physical and emotional control?

Recovery Rationale: During the recovery phase of the aggression cycle, the client regains physical and emotional control. The nurse should help the client relax, sleep, and return to a calmer state.

During which phase of the aggression cycle does the staff usually have a debriefing session?

Recovery Rationale: During the recovery phase, the staff has a debriefing session to discuss the aggressive episode.

Which is not a goal of the working phase of the therapeutic relationship?

Reducing the client's anxieties Rationale: A reduction in anxiety must be achieved by the client, not by the nurse, and indicates a positive outcome of the termination stage.

What nursing action demonstrates the intended impact of the American Nurses Association (ANA) standards of care on mental health nursing care?

Referring to the standards to determine if a particularly prescribed treatment falls within the scope of a nurse's practice. Rationale: The American Nurses Association (ANA) develops standards of care as authoritative statements by professional organizations that describe the responsibilities for which nurses are accountable, thus identifying the nurse's scope of practice. They are not legally binding unless they are incorporated into the state nurse practice act or state board rules and regulations. When legal problems or lawsuits arise, these professional standards are used to determine safe and acceptable practice and to assess the quality of care in the court of law. Neither identifying advanced level functions or safety delegation principles are directly associated with the ANAs nursing standards.

Children of parents who abused alcohol and substances are able to develop self-esteem and self-efficacy by developing which characteristics?

Resilience Rationale: Resilience is having healthy responses to stressful situations or risky environments. Hardiness is the ability to resist illness when under stress. Social skills are a type of coping strategy. Tolerance is the ability to deal with increasing levels of stress in an adaptive way.

A client is engaged in the orientation phase of the nurse-client relationship. The client should be involved in which activity?

Seeking assistance Rationale: During the orientation phase, the client seeks assistance, identifies needs, and commits to a therapeutic relationship; the client begins to test the relationship later in this phase. The client discusses underlying needs and tests new ways to solve problems in the working phase. The nurse is responsible for establishing boundaries during the orientation phase.

Considering the nature of its content, which areas may be the most uncomfortable or difficult for the nurse to assess?

Sexuality Rationale: Two areas that may be uncomfortable or difficult for the nurse to assess are sexuality and self-harm behaviors, which are both very personal areas. None of the remaining options are that personal in nature.

An aggressive client is holding a weapon and threatening to harm other clients in the unit. How should the nurse handle this situation?

Shield oneself with a pillow Rationale: An armed, aggressive client is dangerous and potentially harmful. The nurse should shield oneself form the client's weapon using a pillow, mattress, or folded blanket. It helps to protect against any potential harm. The nurse should never try to subdue an armed client as the client may harm the nurse. Reaching out to the client's weapon may increase harm to the nurse. Instructing the client may not be helpful, as the client may not be able to follow the instructions.

The nurse is performing an assessment of a client with a psychiatric illness. The nurse has 10 cards with different inkblot shapes. Which test is the nurse about to perform?

The Rorschach Test Rationale: The Rorschach Test is a projective personality test. It includes the use of 10 stimulus cards with inkblots. The client has to describe perceptions of inkblots. This test is useful to understand the coping styles, interpersonal attitudes, and characteristics of ideation. The Thematic Apperception Test uses 20 stimulus cards with pictures. The client tells a story about the picture. The Tennessee Self-Concept Scale and the Psychological Screening Inventory are objective personality tests. The Tennessee Self-Concept Scale includes 100 true-false questions that provide information on 14 scales related to self-concept. The Psychological Screening Inventory consists of 103 true-false questions. The result of the test indicates whether the client needs psychological help.

A nurse is assessing a Korean client. The caregiver of the client tells the nurse that the client had been diagnosed with Hwa-Byung by their local health care provider. What should the nurse interpret from this?

The client had health-related issues due to suppression of anger. Rationale: Hwa-Byung, or fire illness, is a culture-bound syndrome in Korea where a client has symptoms such as abdominal pain and insomnia as a result of suppression of anger. A nurse who is aware of the culture bound syndromes would understand that the client's health-related complaints are due to suppression of anger. Somatization is an incorrect diagnosis for this condition, often given by Western practitioners unaware of Hwa-Byung. Paranoid delusions and hallucinations are not seen in this culture-bound syndrome. This condition is not known to include intermittent episodes of anger outbursts.

The nurse-client relationship is classified as which type of relationship?

Therapeutic Rationale: The nurse-client relationship is classified as a therapeutic relationship. It is not classified as a social, intimate, or friendly relationship.

a client has a prescription for haloperidol, 5 mg orally two times a day, as ordered by the physician. The client is suspicious and refuses to take the medication. The nurse says "If you don't take this pill, ill get an order to give you an injection." The nurses statement is an example of

assault

a hospitalized client is delusional yelling "The world is coming to an end. We must all run to safety!" when other clients complain that this client is loud and annoying. the nurse decides to put the client in seclusion. The client has made no threatening gestures or statements to anymore the nurses action is an example of

false imprisonment

What activity should be included in the first step of self-awareness?

identifying one's own values, attitudes, strengths and weakness Rationale: One tool that is useful in learning more about oneself is the Johari window. In creating a Johari window, the first step is for the nurse to appraise his or her own qualities by creating a list of them: values, attitudes, feelings, strengths, behaviors, accomplishments, needs, desires, and thoughts. The second step is to find out others' perceptions by interviewing them and asking them to identify qualities, both positive and negative, they see in the nurse. To learn from this exercise, the opinions given must be honest; there must be no sanctions taken against those who list negative qualities. The third step is to compare lists and assign qualities to the appropriate quadrant.

the primary purpose of the community mental health center act of 1963 was to

move patients to their home, communities for treatment

the client tells the nurse "I never do anything right. i make a mess of everything. ask anyone; they'll tell you the same thing "The nurse recognizes these statements as an example of

negative thinking

When an Arabic client newly diagnosed with type 2 diabetes is insistent that the client's family provide all food, the nurse initially ...

provides the client and the client's family with detailed instructions with the dietary requirements of the condition. Rationale: The nurse provides culturally congruent nursing care so that the client's cultural perspective is preserved or maintained and negotiates with the client when changing the client's practices is necessary for health. While not inappropriate, explaining to the family to check with staff is not the initial nursing intervention for this scenario. Requesting a dietary consultation may not be realistic but even if possible, it is not the initial nursing intervention for this scenario. While informing the primary care provider is not inappropriate, it is not the initial nursing intervention for this scenario.

to assess the clients ability to concentrate the nurse would instruct the client to so which

repeat the days of the week backwards

The client who is involuntarily committed to an inpatient psychiatric unit loses which right?

right to freedom

A nursing instructor is describing the nurse-client relationship to a group of nursing students. Which would the instructor emphasize as most important to establishing and maintaining the relationship?

self-awareness Rationale: Self-awareness is crucial in a nurse-client relationship. Without it, nurses will find it impossible to establish and maintain therapeutic relationships with clients. Although rapport and empathy are important considerations for a nurse-client relationship, self-awareness is key. Values are inherent in nurses, and a nurse must be self-aware of his or her own values.

What should the nurse avoid when demonstrating genuine interest for a client by making a self-disclosure?

shifting the emphasis to the nurse Rationale: Self-disclosure examples are most helpful to the client when they represent common day-to-day experiences and do not involve value-laden topics. Self-disclosure can be helpful on occasion, but the nurse must not shift emphasis to his or her own problems rather than to the client's. None of the option are inappropriate

The nurse indicates interest in and acceptance of the client by all of the following except:

sitting behind a desk. Rationale: Sitting behind a desk does not indicate interest in and acceptance of the client by the nurse.

When considering where to conduct a psychosocial assessment, the nurse can effectively interview which client in the unit's conference room?

the anxious client Rationale: The nurse should not choose an isolated location such as a conference room for the interview, if the client is unknown to the nurse or has a history of any threatening behavior either to themselves or to others. The anxious client by diagnosis does not present a threat and so is the one best suited for the nurse to use the conference room for the interview.

Which verbal cue refers to accents on words or phrases that highlight the subject or give insight on the topic?

Emphasis Rationale: Emphasis refers to accents on words or phrases that highlight the subject or give insight on the topic. Tone can indicate whether someone is relaxed, agitated, or bored. Pitch carries from shrill and high to low and threatening. Intensity is the power, severity, and strength behind the words.

A nurse has approached a new client on the psychiatric care unit in order to establish a therapeutic relationship and conduct a focused assessment. As the nurse approaches the client, the client says, "Oh good. Here comes one more person to tell me that I'm crazy." Which of the nurse's following responses would constitute countertransference?

"There's no need to get rude with me. I'm just trying to do my job and to help you out." Rationale: Reciprocating a client's hostile or sarcastic tone is an example of countertransference, in which the nurse responds unrealistically to the client's behavior or interaction.

the client tells the nurse, "The biggest problem right now is trying to deal with a divorce. i didn't want a divorce and i still don't. but it is happening anyway!" which of the following responses by the nurse will convey empathy?

"sounds like it has been a difficult time."

Chlorpromazine is a drug in which classification?

Antipsychotic Rationale: Thorazine is a first generation antipsychotic medication.

The nurse is providing information to the caregivers of the client who has been secluded. Which statements about the implementation of the seclusion are correct? Select all that apply.

-"The client will be assessed by the nurse every 1 to 2 hours." -"The client can also be monitored by audio and video equipment." -"The health care provider will review the seclusion order every 4 hours." -"The client will be assessed by a specialized independent practitioner within the hour." Rationale: After the client is secluded, the nurse documents assessment of the client every 1 to 2 hours. The health care provider is required to review the client's seclusion order every 4 hours. A specialized practitioner is required to assess the client within 1 hour after the seclusion. After the client has been monitored 1:1 for 1 hour, the staff can use video and audio equipment to continue the monitoring. The client cannot be released from seclusion until specific behavioral criteria are met. Thus, the nurse cannot tell the caregivers that the client will be removed from seclusion in 1 day.

A client has been estranged from the client's parents for several years, and they have expressed a desire to reconcile with the client. The client initially agreed to a meeting but has told the nurse that the client plans to cancel it at the last minute. The nurse has encouraged the client to attend the meeting, knowing that the family's support would be valuable. What ethical principles are in conflict in this situation? Select all that apply.

-Autonomy -Beneficence Rationale: There is tension between the client's autonomy (the right to attend or carry out the meeting as the client desires) and the nurse's desire to promote good (i.e., beneficence—facilitate the family's support).

Deinstitutionalization has reduced the number of public hospital beds by what percentage?

80% Rationale: Although deinstitutionalization has reduced the number of public hospital beds by 80%, the number of admissions to those beds correspondingly increased by 90%.

Which is a result of deinstitutionalization?

A "revolving door" of repetitive hospital admissions Rationale: One result of deinstitutionalization is the "revolving door" of repetitive hospital admission without adequate community follow-up. There are decreased community resources, and the majority of those who are mentally ill are unable to achieve independence.

Which term is used to describe general feelings or a frame of reference around which a person organizes knowledge about the world?

Attitudes Rationale: Attitudes are feelings or a frame of reference around which a person organizes knowledge about the world. Values are abstract standards that give a person a sense of right and wrong and establish a code of conduct for living. Beliefs are ideas that one holds to be true. Self-awareness is the process of developing an understanding of one's own values, beliefs, thoughts, feelings, attitudes, motivations, etc.

A client informs the nurse that the client is feeling better and does not want to take antidepressant medication. This client is exhibiting which ethical principle when making this decision?

Autonomy Rationale: The client is practicing autonomy and the principle that each client has the fundamental right of self-determination.

Which client most likely has the legal right to refuse treatment?

A client who voluntarily entered a substance abuse treatment facility to address an addiction to alcohol Rationale: Many people who are psychiatric inpatients have been admitted involuntarily as a result of the threat they pose to themselves or others. Competent clients who admit themselves voluntarily have the right to refuse any treatment prescribed and may initiate their own discharge at any time.

As a result of the increasing severity of delusions and consequent unsafe behavior, a client has been admitted to a psychiatric facility and judged incompetent to make decisions. Who will now make decisions for the client?

A guardian appointed by the court rational: If individuals admitted to a psychiatric facility are judged to be incompetent to make decisions, the court will appoint a guardian to make decisions for them.

What is provided in the Code of Ethics for Nurses of the American Nurses Association (ANA)?

A guideline for nurses regarding ethical conduct Rationale: The ANA's Code of Ethics for Nurses guides ethical decision-making.

"Get the stuff from him" is an example of which type of message?

Abstract Rationale: "Get the stuff from him" is an example of an abstract message. In concrete messages, words are explicit and need no interpretation. Concrete messages are clear, direct, and easy to understand.

Which client behavior would prompt the nurse manager to discuss the duty to warn with staff members?

Danger to others. Rationale: Duty to warn refers to the responsibility of the nurse or the health care provider to warn identifiable third parties of threats made by clients. If the client is dangerous to any other member, the nurse is supposed to notify the person in danger immediately about the client's ideation. This law is not applicable to the client who has suicidal ideation, is extremely aggressive, or is unwilling to take medications. Client confidentiality is a very strict policy that should be abided by the nurses in any other circumstances.

Earlier in the shift, the nurse promised to help a client acquire some paper and a pen and draft a letter to a family member later in the day. The nurse became increasingly busy during the shift but has now taken some time to assist the client in this way. What ethical principle has the nurse best exemplified?

Fidelity Fidelity involves keeping promises. Veracity is truth-telling while beneficence is doing good and nonmaleficence is avoiding harm.

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?

Report the incident to staff and the clinical instructor so boundaries can be reenforced with the client. Rationale: Some clients have difficulty recognizing or maintaining interpersonal boundaries. When a client seeks contact of any type outside the nurse-client relationship, it is important for the student (with the assistance of the instructor or staff) to clarify the boundaries of the professional relationship. The behavior should not be ignored or minimized but rather addressed in a professional, matter-of-fact manner so that the client understands the limits being placed on such behaviors.

Which is a criterion for mental health?

Satisfaction with personal relationships and self Rationale: People in a state of emotional, physical, and social well-being fulfill life responsibilities, function effectively in daily life, and are satisfied with their interpersonal relationships and themselves. None of the remaining options fully satisfy the criteria for a healthy mental status.

Which type of touch, according to Knapp, is used in greeting, such as a handshake?

Social-polite Rationale: Social-polite touch is used in greeting, such as a handshake. Functional-professional touch is used in examination or procedures. Friendship-warmth touch involves a hug in a greeting. Love-intimacy touch involves tight hugs and kisses between lovers or close relatives.

Short-term use of restraints is permitted only in which situation?

The client is imminently aggressive and a danger to the self or others. Rationale: Short-term use of restraints is permitted when the client is imminently aggressive and a danger to the self or others. Noncompliance with treatment, wanting to leave the hospital without an order to do so, and client agitation and talkativeness are not reasons to apply restraints.

A psychiatric nursing class is discussing current trends in mental health care. A student voices the opinion that there should be equitable access to mental health care and resources for those who live in rural areas, for those without health insurance, and for those with very little income. The student nurse's opinion most closely reflects which ethical principle?

justice Rationale: Justice is the duty to treat all fairly, distributing the risks and benefits equally. Justice becomes an issue when some portion of a population does not have access to health care. Nonmaleficence is the duty to cause no harm, both individually and for all. Paternalism is the belief that knowledge and education authorize professionals to make decisions for the good of clients. Veracity is the duty to tell the truth.

building trust is important to

the orientation phase of the relationship

Which statements made by the nurse demonstrate a need for additional education regarding the use of seclusion? Select all that apply.

-"Seclusion helps the client to be more active." -"Seclusion minimizes the use of psychotropic drugs." Rationale: Seclusion is used to give the client the opportunity to regain physical and emotional self control. Clients in seclusion do not tend to become more active. Psychotropic drugs may be administered to the client in seclusion. While in seclusion, the client may experience a reduced number of stimuli. Seclusion also helps in protecting the privacy of the client and prevents the client from harming others.

The advanced practice registered nurse is planning interventions for clients in a mental health practice. Which are considered basic level?

-Ensuring a therapeutic environment -Improving client function and health Rationale: Ensuring the existence of a therapeutic environment is within the domain of milieu therapy and is considered a basic-level function of a registered nurse. Improving client function and health are within the domain of self-care activities which is a basic-level function and can be performed by the registered nurse. Consultation, psychotherapy, and prescriptive authority and treatment are the advanced interventions performed by an advanced practice registered nurse.

A nurse and client are in the orientation phase of the nurse-client relationship. Which behavior would occur during this phase? Select all that apply.

-Explanation of the purpose of the relationship -Discussion of client's expectations -Reviewing the client history Rationale: During the orientation phase, the nurse explains the purpose of the relationship, discusses the client's expectations, and listens to the client's history and perception of the problems. The nurse begins to understand the client and identify themes. Exploration of problems occurs during the working phase. Strengthening of relationships occurs during the resolution phase.

A nurse is engaged in a therapeutic nurse-client relationship. The relationship is in the working phase. The nurse recognizes the client should be involved with which actions? Select all that apply.

-Testing new ways for problem solving -Discussing problems related to needs -Examining personal issues Rationale: During the working phase, the client discusses problems underlying the needs, uses the emotional safety of the relationship to examine personal issues, and tests new ways of solving problems. Identifying a need and testing the relationship typically occur during the orientation phase of the relationship.

Which is an inaccurate depiction of self-awareness?

It involves changing one's values or beliefs. Rationale: The goal of self-awareness is to know oneself so that one's values, attitudes, and beliefs are not projected to the client, interfering with nursing care. Self-awareness does not mean having to change one's values or beliefs, unless one desires to do so.

Which action by the nurse or client represents the working phase of the therapeutic relationship?

Identifying past ineffective behaviors Rationale: In the working phase of the relationship, the client is involved actively in achieving goals set during the initial phase. The tasks of the working phase of the therapeutic relationship include identifying past behaviors that have been ineffective for coping with the focal problem; developing a plan of action, practicing implementing it, and evaluating its effectiveness; integrating a new self-concept, worldview, or attitude toward one's illness as a result of changes in behavior and circumstances; and increasing hopefulness for the future and ability to function independently. Communicating interest in the client is the role of the nurse, and this takes place in the orientation phase of the relationship. The client tests the relationship during the orientation phase. Reviewing the work that has been done takes place during the resolution phase of the relationship.

A client who is schizophrenic is catatonic and has a mask-like face. Which facial expression is being exhibited?

Impassive Rationale: An impassive face is frozen into an emotionless deadpan expression similar to a mask. An expressive face portrays the person's moment-by-moment thoughts, feelings, and needs. A confusing facial expression is one that is the opposite of what the person wants to convey, or incongruent.

Which intervention is focused on a goal included in Healthy People 2020 Mental Health objectives?

Including a depression screening in the assessment interview conducted by the staff of a group of family practitioners Rationale: One of the Healthy People 2020 Mental Health objectives is to increase depression screening by primary care providers. While the remaining options may present positive interventions, none are directly associated with Healthy People 2020 Mental Health objectives.

Initially, the nurse should focus on successfully achieving which goal in order to effectively provide care for a client diagnosed with a mental illness?

Establishing trust and rapport with the client Rationale: Establishing trust and rapport are the most important components when caring for a client with mental illness. Without this foundation, therapeutic nursing care is not possible. The nurse does not offer advice but rather works with the client to arrive at effective solutions to existing problems. Reasonable limits regarding the actual work that is accomplished is important but limits can't be set or enforced until there is a therapeutic relationship established. The nurse-client relationship is therapeutic in its nature; it does not involve a social friendship.

The inappropriate use of restraints or seclusion is considered which form of intentional tort?

False imprisonment Rationale: False imprisonment is defined as the unjustified detention of a client, such as the inappropriate use of restraint or seclusion. Battery involves harmful or unwarranted contact with the client. Assault involves any action that causes a person to fear being touched in a way that is offensive, insulting, or physically injurious without consent or authority. Causation occurs when a breach of duty was the direct cause of loss, damage, or injury.

A nurse tells a client that the nurse will bring the client pain medicine in 5 minutes after checking on another client. The nurse returns in 5 minutes and administers the medication as planned. The nurse is practicing which principle by returning as promised?

Fidelity Rationale: Fidelity is faithfulness to obligations and duties. It is keeping promises and is important in establishing trusting relationships.

Which communication technique involves giving encouragement to the client, enabling continuance of the conversation and indicting that the nurse is listening?

General leads Rationale: General leads give encouragement to continue. Focusing is concentrating on a single point. Accepting is indicating reception. Exploring is delving further into a subject or idea.

Which is a difference between counseling and psychotherapy?

Generalist psychiatric nurses may perform counseling interventions, but psychotherapy is an advanced practice role. Rationale: The psychiatric nurse uses counseling interventions, but psychotherapy requires advanced certification according to the American Nurses Association. Psychotherapy is not reserved solely for those who have not responded to counseling. Transference and countertransference are significant obstacles in both modes, and neither intervention is appropriate during acute psychotic episodes.

Which is an example of a nontherapeutic communication technique?

Giving approval Rationale: Giving approval is sanctioning the client's behavior or ideas. Summarizing is organizing and summing up what has gone before. Silence is the absence of communication. Voicing doubt is expressing uncertainty about the reality of the client's perceptions.

When staff members physically control the client and move him or her to a seclusion room, what form of restraint is being implemented?

Human Rationale: Human restraint is when staff members physically control the client and move him or her to a seclusion room. A mechanical restraint is a device, usually ankle or wrist restraints, fastened to a bed frame to curtail the client's physical aggression. Long- and short-term restraint refers to the time frame for the use of the restraint.

Which state allows for an insanity defense?

Iowa Rationale: Iowa has not abolished the insanity defense. Idaho, Montana, and Utah have abolished this defense.

While performing the admission assessment of a new client, the nurse observed that the client brought a bottle of over-the-counter pain medication to the hospital. The nurse failed to document this or remove the medication from the room. Subsequently, the client experienced a serious adverse drug reaction as a result of the interaction between this drug and one of the drugs that the client was prescribed in the hospital. This nurse may be guilty of what?

Malpractice Rationale: The four elements of nursing malpractice are evident in this scenario. Assault is an act that puts another person in apprehension of being touched (or of bodily harm without consent), and failure of duty to warn surrounds a client's threat to harm another person. Incompetence, in the legal sense, surrounds a client's right to autonomy.

Which ethical principle focuses on the duty to do no harm?

Nonmaleficence Rationale: Nonmaleficence is the requirement to do no harm to others either intentionally or unintentionally. Autonomy involves the right of the client to make his or her own decisions. Justice refers to fairness. Beneficence refers to one's duty to benefit or promote good for others.

Which ethical principle requires a nurse to prevent clients from harming themselves or others?

Nonmaleficence Rationale: Nonmaleficence is the requirement to do no harm to others either intentionally or unintentionally. Beneficence refers to one's duty to benefit or promote good for others. Autonomy involves the right of the client to make his or her own decisions. Justice refers to fairness.

It is the nurse's responsibility to define the boundaries of the relationship during which phase of the nurse-client relationship?

Orientation Rationale: During the orientation phase, the nurse's responsibility is to define the boundaries of the relationship. The orientation phase of the nurse-client relationship involves the establishment of a therapeutic environment by the nurse. The working phase of the nurse-client relationship includes exploration of feelings and participation in identifying problems. The termination phase is the final stage in the nurse-client relationship. Problem identification occurs in the working phase.

Which zone is a distance that is comfortable between family and friends who are talking?

Personal Rationale: The personal zone is the distance that is comfortable between family and friends who are talking. The intimate zone is the amount of space that is comfortable for parents with young children and people who mutually desire personal contact. The social zone is the distance acceptable for communication in social, work, and business settings. The public zone is an acceptable distance between a speaker and an audience.

A client diagnosed with schizophrenia is hallucinating. Which communication technique may the nurse use to redirect the client?

Presenting reality Rationale: Presenting reality is offering for consideration of what is real. Reflecting is directing client actions, thoughts, and feelings back to the client. Making observations is verbalizing what the nurse perceives. Seeking information is seeking to make clear something that is not meaningful or that is vague.

Which intervention is appropriate for a psychiatric-mental health nurse at the basic level of practice?

Promoting symptom management Rationale: Basic psychiatric-mental health nurses promote and encourage the maintenance of health and prevention of disorders, assess biopsychosocial functioning, serve as case managers, design therapeutic environments, and promote self-care activities, including medication and symptom management. At the advanced level, psychiatric-mental health nurses deliver comprehensive primary mental health services. Functions include teaching and screening, performing preventive interventions, and evaluating and managing care for people with mental illness.

Which zone is an acceptable distance between a speaker and an audience?

Public Rationale: The public zone is an acceptable distance between a speaker and an audience. The intimate zone is the amount of space that is comfortable for parents with young children and people who mutually desire personal contact. The personal zone is the distance comfortable between family and friends who are talking. The social zone is the distance acceptable for communication in social, work, and business settings.

A nurse is interviewing a client to obtain a health history. Which would be considered a "usual or expected" response during the first session?

Rambling due to nervousness Rationale: A client is usually nervous and insecure during the first few sessions and may exhibit behavior reflective of these emotions, such as rambling. Showing up late, being confrontational, and bragging are nontherapeutic ways to not participate in the session.

The nurse gives the client quetiapine (Seroquel) in error when olanzapine (Zyprexa) was ordered. The client has no ill effects from the quetiapine. In addition to making a medication error, the nurse has committed which of the following?

a) malpractice b) negligence c) tort (unintentional) d) none of the above D is the answer