Mental Health Exam 4
Noelle is a patient on the psychiatric unit. She is scheduled to start group therapy today. She asks you, "What does group work mean? My provider said I would be going to group and doing group work." Your best response is:
"You will give and receive feedback from a group of your peers who may also have similar problems to work through"
Advantages of groups include: (select all that apply):
-Feedback from peers -Treatment of multiple people at one time -Provision of an opportunity to practice communication -Promotion of a feeling of belonging
Risks of using complementary and alternative medicine (CAM) therapies include: (select all that apply):
-Lack of standards or regulations that ensure safety for herbal products -Not informing health care providers of the use of CAM -interactions between CAM products and prescribed medication -Delayed treatment while experimenting with alternative treatments -Not knowing how much of an ingredient is in supplements because of non-regulation
At the first family therapy session the family tells the therapist that "We wouldn't have to be here if our younger son wasn't such a brat. He seems so different from our other son. We never had difficulty with him misbehaving." The other sibling offers "He gets upset pretty easily." The nurse should suspect that the younger son is
Being scapegoated
Which supplement could be recommended for Elaina's complaints of hot flashes?
Black cohosh
How should the nurse counsel a client who plans to use CAM to treat relapse of schizophrenia with regard to efficacy and cost? "The cost of
CAM may be lower, but its efficacy of treatment cannot be assured"
A client asks which herbal tea would be good to drink at bedtime. The best answer would be
Chamomile tea
The nurse leader of a cognitive therapy group for persons with dysphasia would use the technique of
Clarification
The family function that helps define the roles of family members and allows for differences among members is
Clarity
A nurse is the leader for a medication group for clients diagnosed with bipolar disorder. No new clients will be added as the group progresses, and so the group is considered
Closed
A nurse is asked to explain the difference between alternative and complementary therapy. The best answer is
Complementary therapy is used in conjunction with conventional Western remedies, whereas alternative therapies replace conventional Western remedies
A key quality indicator that might be identified for successful outcome in a medication education group could be that clients will
Confer with health care provider before changing medication regimen
One of the roles of a case manager working with severely and persistently mentally ill clients who are homeless is to
Coordinate needed services and provide outreach
The goal of a nurse working in psychiatric rehabilitation would be to help clients in the community
Cope more effectively with their symptoms
A client says to the nurse, "I am going to stop taking these antidepressants and start using herbs. After all, they..." The client will probably complete the statement with the reason that herbal preparations
Cost less
A nurse is asked by a client about the basis for the use of alternative and complementary therapies. The best reply would incorporate the information that alternative and complementary therapies are based on
Cultural and historical experience
The nurse who assesses a family as having enmeshed boundaries includes the care plan goal of "Family members will
Define individual beliefs and needs"
During a family therapy session the mother says to her daughter, "I would like to know why you took the piece of pie that was left after dinner last night. You knew I wanted it." Later the father tells his daughter, "I know exactly why you did that." The nurse therapist should consider the possibility that the family has
Diffuse boundaries
The nurse working with a client in the partial hospitalization program seeks advice from the psychiatric clinical nurse specialist to help a client who has auditory hallucinations. The clinical nurse specialist would most likely suggest which of the following cognitive interventions for this client?
Distracting technique
What is the group leader's responsibility in the termination phase?
Encouraging group members to reflect on progress made
Marnie is the nurse working with a family whose boundaries are not clear and whose members are overinvolved with each other. The term that describes this type of family dynamic is:
Enmeshment
A family consists of a husband, a wife, their three children, and the wife's mother. This family form is called a(n)
Extended family
A client tells the nurse he has been taking St. John's wort. On the basis of this information, the nurse should gather additional assessment data about
Feelings of depression
When the group leader suggests that a client "choose the problem that is troubling you most at this time and tell us about it." The leader is promoting
Focusing
Which technique would be least helpful in putting family members at ease as family therapy begins?
Focusing on the identified patient's views about the family problems
During a family therapy session a wife states, "My husband is always angry.The children and I are always on edge. We can never relax." The nurse identifies the wife's communication technique as
Generalizing
A highly useful tool to uncover multigenerational issues in a family is the
Genogram
A client tells the nurse, "My memory was getting worse. The health foods store gave me this bottle of pills and said my memory should improve in a month or so." The nurse can expect that the remedy given to the client contains
Gingko biloba
Elaina, a 53-year-old patient with a pacemaker and history of cerebrovascular accident (stroke) for which she takes Coumadin, comes to see her provider at the office where you work. She tells you she "feels so much better" now that she is taking ginseng to relieve her menopausal symptoms. Your best response is based on the knowledge that:
Ginseng has anticoagulation effects
The mother of a client with severe, persistent schizophrenia tells the nurse, "My son has slipped so far away from me over the past few years. We really don't have a relationship anymore. I miss him." The nursing diagnosis that best describes the mother's feelings is
Grieving
The members of a family openly tell each other what they are thinking and feeling. A nurse listening to their interchanges would assess them as using
Healthy communication
The nurse giving information about alternative and complementary therapies would best describe them as
Holistic
A nurse is asked to give an example of an alternative medical system; the best example is
Homeopathy
Using a minute amount of a substance that produces the same symptom as the client's chief symptom, so as to stimulate the body's immune system, is the rationale for use of the remedies prescribed in
Homeopathy
Psychiatric nurses use basic nursing interventions in all settings. The basic nursing interventions include all but which of the following?
Housing access
The nurse working with a client diagnosed with severe and persistent mental illness will implement rehabilitation principles by
Identifying and reinforcing the client's strengths
Care that places the patient at the center of care, focuses on prevention and wellness, and attends to the patient's physical, mental, and spiritual needs is referred to as:
Integrative
Jeremiah is being discharged from the hospital. Which interventions and/or goals related to planning for discharge would support the recovery model of care?
Interventions will focus on Jeremiah's stated wish for independent living
A client diagnosed with a severe mental illness and institutionalized for most of his adult life has recently been transferred to a supervised community-based residential home that houses several other adult men. The client is resistant to going to day therapy and has begun to socially isolate if allowed. He has an apparent weight loss and has become uncooperative. The most likely reason for these changes is that he
Is experiencing a decreased sense of self
A client has been diagnosed with acute anxiety attacks. Which herbal remedy should the nurse caution the client to avoid?
Kava
Blaine is an advanced practice nurse running a group on the adolescent unit. The patients are talking about their favorite music and artists. Blaine makes no attempt to control the topic or the member's behavior and makes no comment unless he is asked a direct question. Blaine's leadership style is:
Laissez-faire
A girl is overheard saying to her brother, "If you stick up for me with mom and dad, I will forget I heard you planning to sneak out after they are asleep." This can be assessed as a type of communication called
Manipulative
Which statement best reflects how clients who are severely and persistently mentally ill generally perceive how others in the community see them?
Many feel stigmatized and alienated
A treatment group that a novice psychiatric nurse is likely to be assigned to lead is
Medication education
The client, who is the eldest son in a family in which the father was an alcoholic and the mother was an enabler, drinks heavily and has married a woman who never complains about his drinking. This scenario suggests a
Multigenerational issue
The nurse cautions a client about the fact that, when using herbal preparations, the client does not know the actual dose being ingested. What is the basis for this caution?
No manufacturing standardization exists
The nurse reading a group protocol notes that it is a closed group and understands that
No new members will be allowed
The family that consists of a married mother and father and three biological children all living together is referred to as a(n):
Nuclear family
Which is true of the relationship between SMI and substance abuse?
Of those with SMI, 60% also abuse substances
The complementary and alternative medicine (CAM) practitioner is asked by a client why aromatherapy makes her feel more relaxed and healthy. The practitioner's answer will be that the basis for aromatherapy is
Olfactory nerve stimulation to send messages to the limbic system
At what phase of group development would the nurse hear the following interchange? Client 1: "I do not feel comfortable here." Client 2: "I wonder what we are supposed to talk about." Client 3: "Let's ask the leader to explain things again."
Orientation
The phase most influenced and managed by the group leader is
Orientation
Institutionalization leads to what specific type of behaviors in adults old enough to have been confined to institutions before deinstitutionalization?
Passivity and dependence
Self-help and support groups are least influenced by the premise that
Professional leadership is inappropriately expensive for treatment of minor problems
The group goals are to learn to express feelings comfortably rather than keep them covert. When a group member shares with the group how expressing these feelings makes her feel, she is engaging in
Providing feedback
Grace is the nurse working with the Potter family, which consists of married parents Todd and Rhea, 16-year-old Jasmine, and 19-year-old Jeremy, who has recently been diagnosed with schizophrenia. The rest of the family is bewildered with Jeremy's symptoms and express that they feel lost in knowing how to deal with things. Which of the following approaches to family therapy would Grace take at this time to provide support and give information to the family that will help them cope with Jeremy's illness?
Psychoeducational family therapy
During family therapy the family's youngest daughter says, "They care more about my sister because she's older and gets straight As in school." The nursing diagnosis with priority focuses on
Relational problems
A community mental health nurse assesses a client and obtains the information listed below. Which assessed data have the least priority?
Reports of dry mouth and eyes
Savannah is a patient with borderline personality disorder who is attending a court-ordered therapy group. She projects an angry affect. She doesn't speak much, but when she does it is usually to make a snide comment about another member of the group or the group's leader. What is the best way for the leader to handle this?
Respond neutrally to Savannah's comments, ask for group feedback, and talk to her privately to form a connection
The phase of group therapy in which the group deals with feelings associated with separation and loss is
Termination
The family consists of the husband and his wife, their four children, the wife's 21-year-old sister, and client's elderly aunt. Which members are considered the client's nuclear family?
The parents and their four children
Shannon tells you that she is nearing the end of a medication trial where she is taking a pill that may improve her symptoms of gastroesophageal reflux disease. She states, "I found out that I was in the section of the study not actually taking the medicine. I don't understand that, because all my symptoms improved!" You realize she may be experiencing:
The placebo effect
The client tells the nurse, "The CAM practitioner asked me to try to relax my mind and let go of my pain. She then passed her hands over me, beginning at my head and working down to my feet, never actually making physical contact with any part of my body. She told me that when the pain begins to bother me, I can relax and let the pain go." The client is describing
Therapeutic touch
An important means of promoting good self-esteem in children is
To communicate validation of individual worth
A client asks the nurse, "Why hasn't any research been done to substantiate the curative effect of homeopathic remedies?" The nurse should reply, "Research on homeopathic remedies is difficult because
Treatment is individualized, and several clients with the same symptom might receive different treatments
As Grace continues to work with the family, Rhea confides that she and her husband Todd have not been getting along well. She states that daughter Jasmine provides much support to her, and that Jasmine "doesn't really like her dad much anymore and doesn't talk to him." Grace suspects:
Triangulation
The client disagrees that her husband should seek a promotion since it will require the family to move. After she discusses the situation with their 12-year-old, the child tells her father she doesn't want to move. The client has engaged in
Triangulation
Sharing similar experiences is a curative factor identified by Yalom as
Universality
A popular misconception about the seriously mentally ill is that they are
Violent and aggressive
At what point would the nurse expect a family to demonstrate the greatest dislocation in the family life cycle?
When a member is diagnosed with multiple sclerosis
A strategy the group leader may use to encourage a nonparticipating member to speak during a session is share with the client that
"What you are thinking is very important to the group"
Grace wants to find out more about the Potter family and tells them she will do a genogram. Rhea asks what a genogram is. The best response would be:
"A genogram will help me see your family structure, history, and current functioning"
Which statement by a young client who has severe and persistent mental illness would alert the nurse to the need for psychoeducational intervention?
"I hear that marijuana helps calm you down"
When the nurse wishes to obtain assessment data about possible use of complementary substances, which query would have the best potential to yield accurate information?
"Tell me every pill and supplement you take regularly"
Which remark would signal to the nurse that there is a teaching need for the family of a client diagnosed with schizophrenia?
"We always reprimand him whenever his behavior is bothersome"
Serious mental illness (SMI) affects how many people in the United States?
5% to 7% of the population
Which family situation should the nurse assess as warranting a referral for family therapy?
A couple are having difficulty dealing with the erratic behavior of their bipolar son. They say, "We're at the end of our rope"
The case manager determines that the client diagnosed with schizophrenia would profit from a structured environment and having simple responsibilities. Which community resource could provide this?
A psychosocial rehabilitation program
A democratic group leadership style is most appropriate for
A psychotherapy group directed toward anger management
The term dual diagnosis refers to having a severe mental illness and
A substance abuse problem
Which situation is the best example of a double bind?
A wife sighs while telling her husband, "You can go out with the boys tonight if it's what you really want to do"
The client at the alcohol treatment center tells his outpatient group, "I went to an oriental medicine place to see if they could do something to help me stay away from alcohol. I ended up with tiny silver rods placed in various spots in my body. They twirled the rods, then removed them. So far I haven't had any cravings since I went there several days ago." The client is describing
Acupuncture
A chiropractic practitioner will explain to clients that chiropractic treatments are effective because
Adjustments put the spinal column in a normal position allowing improved energy flow
When a group member notices another member crying and suggests, "It looks as though you need the floor to tell us what is so upsetting to you." the behavior being demonstrated is
Altruism
When a group member supports and encourages another group member and feels "good" about doing so, the group phenomenon at work is
Altruism
Jeremiah is a 20-year-old Amish patient who was diagnosed with paranoid schizophrenia 1 year ago and who lives with his parents. He is admitted to the psychiatric unit with psychosis because of nonadherence to his medication regime. When you are attempting to educate him about his diagnosis and the need for medication, Jeremiah persistently mumbles, "I don't have mental illness. No, I am not sick." You recognize that Jeremiah may be exhibiting
Anosognosia (an inability or refusal to recognize a defect or disorder that is clinically evident)
Which alternative and complementary treatment modality involves the use of essential oils to release neurotransmitters in the brain?
Aromatherapy
A client who has been prescribed an antipsychotic medication comes to the clinic 3 days after his scheduled visit and demonstrates evidence of restlessness and agitation. He states, "My medicine ran out, and I didn't remember where to get more." The client's case manager will
Arrange for a dose of the client's medication immediately and make necessary changes to his plan of care
A nurse preparing an education plan includes a component designed to help the client access and use community supports. The nurse can consider the educational component successful when the client
Arranges to attend a money management workshop
When a member tells the group, "I think the committee saw how unsure of myself I am. I felt all shaky inside during the promotion interview, just like I am feeling and acting right now." To present reality the leader should
Ask the group to give feedback about how the client appears to them
A function of the entry-level staff nurse in caring for families is to
Assess the amount of stress on the system
At what point in the life of a group lasting 12 sessions should confidentiality be explained and discussed?
At the first session
A 26-year-old client diagnosed with schizophrenia is having difficulty adjusting to his return to the community after hospitalization. His family is dismayed by his poor hygiene and avolition. A useful strategy for the nurse to suggest would be for family members to
Attend a psychoeducational group
An issue for severely and persistently mentally ill clients living in the community is inadequate long-term medication monitoring by community mental health workers. A remedy for this is to
Shift follow-up from social workers to the ACT model
An understanding of the burden borne by a family with a mentally ill family member is best demonstrated by the nurse who
Shows respect and support for the client and family
A client diagnosed with a severe and persistent mental illness tells the case manager, "I think people are laughing at me behind my back. I get real upset and anxious when I have to be around others in the group home. It's better when I just stay by myself." The nurse should consider the nursing diagnosis of
Social isolation
Which of the following is a herb commonly used to treat mild depression?
St. John's wort
When several group members always sit together and nod or smirk as others are talking, the leader assesses this behavior as
Subgrouping
When a client is encouraged to talk with others who have had similar problems, the nurse is suggesting a
Support group
Severely mentally ill clients often express a strong desire to be employed. According to the evidence-based research, the most effective model of employment for these clients is
Supported employment
