Mental Health Nursing

Compensation

(psychiatry) a defense mechanism that conceals your undesirable shortcomings by exaggerating desirable behaviors

Learning cultural differences helps nurse:

- Establish rapport - Ask culturally relevant questions - Identify cultural variables to be considered

Cultural awareness

- Examine beliefs, values, and practices of own culture - Recognize that during a cultural encounter, three cultures are intersecting: culture of the patient, nurse, and setting

Cultural desire

- Genuine concern for patient's welfare - Willingness to listen until patient's viewpoint is understood - Patience, consideration, and empathy

Unknown area

- Johari model - unknown by both

Attack de nervios

- Latin America - Symptoms: Sudden attack of trembling, palpitations, dyspnea, dizziness, loss of consciousness. - Etiology: Evil spirit and intolerable stress - Treatment: Espiritista (healer) and family support

Cultural knowledge

- Learn by studying - Forge friendships with diverse cultural groups

Mother of transcultural nursing

- Madeleine Leininger - sunrise model

How is self disclosure described by using the Johari model?

- when the open area is moved into the hidden area - a patient chooses to share more of themselves

Deviance from cultural expectations can be defined as:

illness by other members of the group

Cultural imposition

imposing your own culture on someone else

Isolation

separation of emotion from an associated thought/memory

What does a western thinker believe about success?

success is obtained in preparing for the future

What are three world views?

- western - eastern - indigenous table 5-2; pg. 86

Eastern tradition

- "balance" - family is a basis for identity - mind/body/spirit is one entity - time is circular - born into a fate thus, there is a duty to comply

Indigenous Culture

- "harmony" - basis of identity is the tribe - person is an entity only in relation to others - disease: lack of harmony between individual and environment

Western tradition

- "science" - identity found in individuality - mind and body are separate - time is linear - disease has a cause & treatment is aimed at the cause

Cultural encounters

- Deter nurses from stereotyping - Help nurses gain confidence in cross-cultural interactions - Help nurses avoid or reduce cultural pain

Jin possession

- Somalia - Symptoms: Distress, anxiety, involuntary abnormal body movements - Etiology: Possession of body by a being called a "Jin" - Treatment: Exorcism by religious leader. Person makes amends to "Jin" for what they have done to anger it.

Populations that are at risk for mental illness & inadequate care

- immigrants - refugees - cultural "minorities"

Five constructs for cultural competence for psychiatric mental health nurses

1. Cultural awareness 2. Cultural knowledge 3. Cultural encounters- exposing yourselve to their culture 4. Cultural skill 5. Cultural desire

The difference between moderate and severe anxiety is that: 1. severe anxiety centers on panic behavior. 2. moderate anxiety motivates learning and creativity. 3. the person experiencing severe anxiety is unable to focus on details of any kind. 4. a person experiencing moderate anxiety can be redirected when instructed to do so.

4. Rationale: The person experiencing moderate anxiety blocks selected areas but can attend to other areas when directed to do so. Severe anxiety occurs prior to panic. Mild not moderate anxiety motivates learning and creativity. Severe anxiety results in focus on details related to relieving the source of the anxiety.

A client was in an automobile accident and while there is the odor of alcohol on his breath, his speech is clear, and he is alert and answers questions posed to him. His blood alcohol level is determined to be 0.30 mg%. What conclusion can be drawn? a. The client has a high tolerance to alcohol. b. The client ate a high-fat meal before drinking. c. The client has a decreased tolerance to alcohol. d. The client's blood alcohol level is within legal limits.

A

Symptoms that would signal opioid withdrawal include a. lacrimation, rhinorrhea, dilated pupils, and muscle aches. b. illusions, disorientation, tachycardia, and tremors. c. fatigue, lethargy, sleepiness, and convulsions. d. synesthesia, depersonalization, and hallucinations.

A

Regression

A reversion to immature patterns of behavior.

Cultural skill

Ability to perform a cultural assessment in a sensitive way

Cody is a 19-year-old college sophomore who has been using cocaine and alcohol heavily for 5 months. He is admitted for observation after admitting to suicidal ideation with a plan to the college counselor. What would be an appropriate priority outcome for Cody's treatment plan while in the hospital? a. Cody will return to a predrug level of functioning within 1 week. b. Cody will be medically stabilized while in the hospital. c. Cody will state within 3 days that he will totally abstain from drugs and alcohol. d. Cody will take a leave of absence from college to alleviate stress.

B

A teaching need is revealed when a client taking disulfiram (Antabuse) states, a. "I usually treat heartburn with antacids." b. "I take ibuprofen or acetaminophen for headache." c. "Most over-the-counter cough syrups are safe for me to use." d. "I have had to give up using aftershave lotion."

C

In helping an addicted individual plan for ongoing treatment, which intervention is the first priority for a safe recovery? a. Ongoing support from at least two family members must be secured. b. The client needs to be employed. c. The client must strive to maintain abstinence. d. A regular schedule of appointments with a primary care provider must be set up.

C

Which of the drugs used by a polysubstance abuser is most likely to be responsible for withdrawal symptoms requiring both medical intervention and nursing support? a. Opiates b. Marijuana c. Barbiturates d. Hallucinogens

C

Which of the following is true regarding substance addiction and medical comorbidity? a. Most substance abusers do not have medical comorbidities. b. There has been little research done regarding substance addiction disorders and medical comorbidity. c. Conditions such as hepatitis C, diabetes, and HIV infection are common comorbidities. d. Comorbid conditions are thought to positively affect those with substance addiction in that these patients seek help for symptoms earlier.

C

Cultural norms

Define what is normal or abnormal within a culture

Which term refers to individuals' belief that their cultural values and practices are correct and superior to those of others? Assimilation Enculturation Ethnocentrism Somatization

Ethnocentrism Ethnocentrism is the universal tendency of humans to think that their way of thinking and behaving is the only correct and natural way. Textbook: pp. 86-88

Which worldview would the nurse anticipate from a client who says, "It is important to save enough money to take care of yourself in your old age. We should not rely on anyone else to take care of us." Eastern (balance) Western (science) Indigenous (harmony)

Western (science) In the Western tradition, one's identity is found in one's individuality, which inspires the valuing of autonomy, independence, and self-reliance. Success in life is obtained by preparing for the future. Textbook: pp. 85-86

Ethnicity

common heritage and history

What does an eastern thinker believe about disease?

disease caused by fluctuations in opposing forces

Culture

is a shared set of beliefs, morals, values that are reflective of way of life

What does Peplau's model describe?

nurse-patient relationship

Somatization

the conversion of mental experiences into bodily symptoms (anxiety might come out as a headache or physical maladies)

Ethnocentrism

the idea that your own group or culture is better or more important than others

Enculturation

the process by which an individual learns the traditional content of a culture and assimilates its practices and values

A nurse seeks to establish a relationship with a patient readmitted to the hospital. The patient has bipolar disorder, depressed type, and was hospitalized the preceding month. Which statement by the nurse would contribute to establishing trust? "Weren't you complying with your medication regimen?" "It must be discouraging to be readmitted to the hospital so soon." "Everyone with bipolar disorder ends up in the hospital occasionally." "You must take your drugs as prescribed or you will be re-hospitalized."

"It must be discouraging to be readmitted to the hospital so soon."

What are the three phases of Peplau's model?

*** - orientation - working phase - termination phase

Sympathy

- "I care about your suffering" - feeling compassion, sorrow, or pity for the hardships that another person encounters

Empathy

- "I feel your suffering" - a person's ability to recognize and share the emotions of another person

A client tells the nurse, "I have something secret to tell you, but you can't tell anyone else." The nurse agrees. What is the likely consequence of the nurse's action? Healthy feelings of sympathy by the nurse toward the client. Blurred boundaries in the nurse-client relationship. Improved rapport between the nurse and client. Enhanced trust between the nurse and client.

- Blurred boundaries in the nurse-client relationship. - keeping secrets indicates that the nurse is overly involved and is one aspect of blurred boundaries. - pg. 134-135

Open area

- Johari model - known by others; known by self

Hidden area

- Johari model - known by self; unknown by others

Self disclosure and feedback will provide:

- Johari model - the shared knowledge that will move more into the unknown area

Blind area

- Johari model - unknown by self; known by others

Factors that promote patient growth

- be genuine - have empathy - be positive - attentive - do not judge other people - help patients develop resources

What are some factors that help the nurse-patient relationship?

- being consistent - pace-timing - listening to what your patients have to say - a good first impressions - promoting patient comfort & balancing control *

Therapeutic Relationships

- clear boundaries established - help patient examine self-defeating behaviors & develop new coping skills - encourage changes in behavior

Orientation phase

- establishing the relationship - discussing the parameters - confidentiality - prepare for termination on the first day

The Johari Window

- facilitates personal growth & awareness - useful in discovering strengths, blindspots, & areas that could be improved - works best in a high trust environment

Working phase

- maintain relationship - continuously promote the patient's: self-esteem and their problem-solving skills - facilitate behavioral change - if necessary, redefine problems & goals

Feedback according to the Johari model:

- must be constructive to be of any value - needs to be specific and focused on behavior that can be changed - is when the open area moves into the blind area due to asking and receiving constructive observations

Countertransference

- nurse displaces feelings onto the patient relating to a person from the past - common sign: over-identification with the patient -pg.135: examples of common countertransference reactions

What is the difference between a social and therapeutic relationship?

- social: feelings of friendship - therapeutic: when the nurse has a professional relationship that maximizes patients' growth

Termination phase

- summarize goals & objectives achieved - Discussing ways for the patient to incorporate into daily life any new coping strategies learned - Exchanging memories, which can help validate the experience for both nurse and patient and facilitate closure of that relationship

A client preparing for discharge presents the nurse with a handmade card of appreciation for the care this nurse provided. Should the nurse accept the card?

- the meaning of the gift needs to be examined. If a gift is inexpensive and given at the end of hospitalization when a relationship has developed, the nurse should graciously accept. - pg. 137-138

What is a term used when roles can be blurred?

- transference: when the patient displaces feeling onto the nurse - often results in countertransference

Patient factors include:

- trust - active participation

What are the advantages to the Johari model?

-greater understanding of yourself and others - helps to better understand their interpersonal communication & relationships - builds self awareness

Which action is a demonstration of an affective response to anxiety? 1. Lacking the patience to help an 8-year-old with homework 2. Startling dramatically each time the telephone rings 3. Experiencing frightening nightmares about dying 4. Having little interest in eating or drinking

1. Rationale: Affective responses to anxiety involve emotions such as being impatient. Startling is a physical or behavioral response to anxiety. Nightmares are cognitive responses to anxiety. Anorexia is a physiological response to anxiety.

Which nursing intervention best builds a therapeutic nurse-client relationship? 1.Actively listening as the client expresses his or her thoughts and feelings Correct 2.Intervening when the client begins to state beliefs that come from his or her illness 3.Evaluating a client's behaviors and interpersonal relationships frequently to identify stressors 4.Passively allowing the client to control the communication and tone of the discussions

1. Rationale: An effective nurse-client relationship is built upon communication that encourages and respects varying points of view in a nonjudgmental atmosphere. Challenging beliefs and values is not appropriate until the relationship is well established. Evaluating a client's behaviors and interpersonal relationships frequently to identify stressors is not an initial goal when attempts are being made to establish a therapeutic nurse-client relationship. While the nurse encourages the client to communicate in an honest, unrestricted manner, a passive approach on the nurse's part would not be therapeutic.

It has been estimated that 20%, or 45 million, adults ages 18 or older in the United States have experienced a mental illness in the past year. Which nursing intervention is directed toward addressing the greatest barrier to successful treatment outcomes for these individuals? 1. Educating clients as to the importance of completing their treatment recommendations 2.Identifying resources where medications can be secured at reduced or no cost 3. Actively involving the client in the planning of his or her mental health care 4. Evaluating the client for compliance with his or her plan of care frequently

1. Rationale: For individuals with mental illness who received treatment, 20% quit before completing treatment recommendations. Educating the client as to the importance of completing treatment recommendations will help minimize this barrier. While poor access to prescribed medications can be a barrier, it has not been identified as the greatest barrier to positive care outcomes. While involving the client in his or her personal care planning has been shown to improve compliance, it has not been identified as the greatest barrier to positive care outcomes. While evaluation of client compliance with his or her plan of care is a critical component of care, lack of such an intervention has not been identified as the greatest barrier to positive care outcomes.

An individual is being admitted for psychiatric treatment. The initial role of the nurse regarding this individual's psychopharmacologic therapy is to: 1. gather data to create a baseline assessment that includes a medication history. 2. assess the individual's understanding of the therapeutic value of his or her current medications. 3. evaluate the effectiveness of the medication regime by focusing on the client's current symptoms. 4. begin the admission interview in such a manner that will foster a therapeutic nurse-client relationship.

1. Rationale: It is essential that a thorough patient baseline assessment—including history, physical, laboratory examination, psychiatric evaluation, sociocultural assessment, and medication history be completed for each patient before beginning any treatment. While the incorrect options are appropriate, they do not have priority among the options since therapy is the focus of the question.

A client has not been taking his antidepressant medication as prescribed and is admitted with suicidal ideations. The nurse demonstrates an understanding of a possible underlying cause of a client's noncompliance with the treatment plan designed to help manage his depression when: 1. asking, "Do you feel that you don't have any control over your depression?" 2. assessing the client's understanding of the risk depression presents for suicide. 3. documenting the son's statement that, "We will do everything we can to help." 4. observing the client interacting with family members when they visit the mental health unit.

1. Rationale: Noncompliant people are also struggling for control. Asking the client to discuss feelings related to control will help assess the depth of the problem. While the client's understanding of his dysfunction is important, discussing risk factors will have minimal impact on identifying if the client feels a lack of control over the disorder and the resulting noncompliance with treatment. While family support is important, it will have minimal impact on compliance with treatment if the problem is the client's perceived lack of control of his depression. While effective family interaction is a positive factor in the support a family can provide, it will have little impact on the client's compliance with treatment if the problem is the client's perceived lack of control of his depression.

The nurse recognizes that to best assure success the most important reason to include an individual in the development of his own plan of care is that: 1. his needs are determined by his values. 2. he has a right to participate in all aspects of his care. 3. he has the right to reject any element of his care if he wants to. 4. his mental health is likely the single most important thing to him.

1. Rationale: People are more likely to perceive what is meaningful and consistent with present needs and personal values. Similarly, people behave in a manner consistent with what they believe to be true. In this case, a fact is not what is but what one believes to be true. While it is true that participation in care is a client right, being involved doesn't necessarily support successful care. The client may reject any or all aspects of care; protecting that right does not necessarily support successful care. It is not necessarily true that his mental health is important to him.

When attempting to discuss the possible psychological basis for a client's numerous physical ailments, the nurse bases the communication on the principle that: 1. being physically ill is significantly more acceptable socially than being mentally ill. 2. somatoform illnesses can be just as painful as illnesses resulting from physiological dysfunction. 3. individuals who demonstrate somatoform disorders are usually unable to cognitively understand their disorder. 4. the individual is aware that the cause of his problem is psychological but makes a conscious decision to ignore that fact.

1. Rationale: People are often reluctant to believe that a physical problem may be related to psychological factors. In part, this is because being physically ill is more socially acceptable and less stigmatizing than having psychological problems. The pain associated with somatoform illness is real but does not have a bearing on the psychological basis of these disorders. For some patients demonstrating somatoform disorder, the lack of insight into their condition is not a result of poor cognitive abilities. The individual is not making a conscious decision to ignore the psychological nature of his illnesses.

The nurse demonstrates appropriate Asian-American cultural sensitivity when: 1. substituting the word "sadness" for depression when participating at a health fair at a local Asian-American senior center. 2. anticipating that the Asian-American teenager is well educated concerning the dangers of tobacco and marijuana abuse. 3. being particularly interested in the older Asian-American's view regarding the role of alcohol in managing stress. 4. evaluating the critical thinking skills and short-term recall abilities of the Asian-American female over the age of 70.

1. Rationale: The Asian-American population generally holds the view that mental illness is shameful and will seek to identify alternative reasons for psychiatric disorders. Using a less threatening word like "sadness" as a substitute for depression would be an example of cultural sensitivity. There is no current research to support the belief that Asian-American teenagers are better educated about the dangers of either tobacco or marijuana use, that older Asian-Americans hold a view concerning the role of alcohol in managing stress that differs from the general population, or that elderly Asian-American females experience a high risk for cognitive and memory-related disorders.

Access to mental health care services has been identified as a necessary component in an effective mental health care system. Which intervention demonstrates an attempt to meet the needs of an underserved group of Americans? 1. Establishing a mobile mental health clinic that serves residents in a rural farming community 2. Providing instructions on a variety of stress management techniques to police and fire personnel 3. Conducting eating disorder screenings at local high schools and colleges 4. Educating the parents of adolescents on the signs of depression

1. Rationale: Unmet needs for treatment are greatest in traditionally underserved groups, including residents of rural areas. By bringing mental health services to them this barrier can be minimized. Police and fire personnel, high school and college students, and adolescents are not generally considered underserved groups since they generally have health care insurance or access to school or state services.

A client is questioning why she was told that the nausea she is experiencing with this new antidepressant medication will subside once her medication is regulated. Based on the pharmacologic principle of steady state, the nurse explains that: 1. when her body reaches a steady point where introduction and elimination of the medication are constant the nausea will stop. 2. blood work can be done to determine the appropriate time her body will reach a steady state when the new medication will not cause the nausea. 3. antidepressants commonly cause nausea for the first 10 doses and once her body can steady the absorption of the medication the side effect will stop. 4. antidepressants have a relatively short half life that will allow for the blood serum's steady state to occur within a few days and then the nausea will stop.

1. Rationale: Until the steady state is reached, the drug level in the body continues to fluctuate, accounting for some acute side effects and preventing determination of the optimum dose for a particular patient. Assessing a blood level measurement will not determine when the steady state will occur but rather when the medication present in the blood is at a therapeutic level. Absorption of the medication is not the sole factor to be considered. The half life of the medication is not a primary factor to be considered.

If the stressor that has caused an individual to experience panic-level anxiety is not managed, the outcome will be that the: 1. individual will die. 2. fight-or-flight reaction will be initiated. 3. entire body will be drawn into the panic mode. 4. organs will function at a less than optimal level.

1. Rationale: When the panic of the exhaustion stage of the GAS response occurs unchecked, adaptive mechanisms become worn out and fail. The negative effect of the stressor spreads to the entire organism. If the stressor is not removed or counteracted, death will result. The fight-of-flight reaction occurs in the alarm reaction stage of the GAS response. The panic mode occurs as a response to stress, not as a final outcome. Organs that function at a less than optimal level occurs in the resistance stage of the GAS response.

A client has been voluntarily admitted to a mental health unit for treatment of acute depression. Which client request will the nurse deny based on this type of commitment? 1. Notifying his wife to bring him his personal cell phone 2. Arranging for him to cast his absentee vote for a city election 3. Mailing out his driver's license renewal form as a registered letter 4. Arranging for a private space where he can meet with his attorney

1. Rationale: When voluntarily admitted, the patient retains all civil rights, but having possession of a private cell phone on a mental health unit is not permitted for safety and therapeutic reasons and is not considered a civil right. When voluntarily admitted, the patient retains all civil rights, including the right to vote, the right to have a driver's license, the right to manage personal affairs.

The nurse demonstrates an understanding of the most common co-morbid condition observed in a schizophrenic individual when asking: 1. "Have you ever been diagnosed with an eating disorder?" 2. "How often do you drink enough alcohol to get drunk?" 3. "How old were you when you became sexually active?" 4. "Would you describe yourself as being depressed?"

2. Rationale: About 50% of patients with schizophrenia have a co-occurring substance abuse disorder, most frequently alcohol or cannabis. Assessing alcohol consumption patterns will help identify this co-morbid condition. Eating disorders are not generally observed in the schizophrenic individual. Sexual habits are not generally viewed as being abnormal in the schizophrenic individual. While depression may occur, it is not a primary co-morbid condition.

In the absence of a previous suicide attempt, the nurse is most concerned about a client's risk for self-harm when he shares that: 1. his wife divorced him 6 months ago. 2. he was diagnosed with major depression 10 years ago. 3. his mother experienced postpartum depression after his birth. 4. he often spends days alone in a cabin located miles away from the main road.

2. Rationale: Although previous suicide attempts indicate risk, the longer the time spent depressed is a major factor in determining long-term risk of suicide. Divorce triggers depression in some individuals but is not the greatest risk factor among those provided as not all those experiencing a divorce become depressed. A history of depression in an immediate family member is considered a risk factor but is not the greatest risk factor provided as it does not affect the client directly. Social isolation is considered a risk factor but is not the greatest risk factor among those provided. Episodic solitude may be normal in this individual.

The nurse is confident that an individual prescribed antipsychotic medication has been experiencing medication efficacy and showing insight when he: 1. has been regularly attending his prescribed therapy sessions. 2. is able to effectively assess the reality of his thinking processes. 3. can restate the importance of medication compliance. 4. no longer experiences hallucinations or delusional thinking.

2. Rationale: Attaining insight is demonstrated by the ability to make reliable reality checks. This takes 6 to 18 months and depends on medication efficacy and ongoing support. While attending therapy sessions and restating the important of medication compliance are positive behaviors, they do not show insight since there is no critical thinking involved. The lack of hallucinations or delusion thinking reflects positive outcomes but not necessarily insight since there is no critical thinking involved.

A 3-year-old child is admitted for an extensive stay in an acute care hospital. The parents will be able to visit only on weekends. The nurse bases emotional care of the child on her understanding that: 1. children are emotionally resilient at this age. 2. the child is at risk for physical illnesses resulting from the separation. 3. the nursing staff can act as effective substitutes for the child's parents. 4. providing appropriate stimulating activities will minimize the child's stress-related risks.

2. Rationale: Children who have been separated from their mothers, especially if placed in an impersonal environment, show a decline in physical health. Resiliency will not be sufficient to overcome the effects of separation from parents. The nursing staff may attempt to be substitutes for the parents, but at this age, the child will be aware of the separation and experience the negative effects. Stimulation will address cognitive and development needs but not emotional ones.

A client's history documents that there have been examples of indirect self-destructive behavior. Which nursing assessment data supports this diagnosis? 1. Client has attempted suicide on three other occasions. 2. Reports of abusing alcohol since the age of 16. 3. Client experiences episodes of hypoglycemia on a regular basis. 4. While acknowledging suicidal thoughts, the client denies any plan.

2. Rationale: Indirect self-destructive behaviors are any activity harmful to the person's physical well-being that may result in death. Alcohol abuse is an example of such behavior. A suicide attempt is a direct self-destructive behavior. Regular episodes of hypoglycemia an example of risk for physical harm but not necessarily of self-destructiveness unless there is some element of conscious attempt at self-harm. Suicidal thoughts without a plan are considered direct self-destructive behaviors.

Currently, the mental health system in the United States focuses on managing client disabilities. It has been suggested that the focus be changed. Which nursing intervention demonstrates an attempt to work toward that recommended focus? 1. Assessing the depressed client often for suicidal ideations 2. Teaching stress management techniques to new mothers 3. Sharing the client's wish that his medications be provided in liquid form if possible 4. Discussing with the client when his follow-up mental health visit can be scheduled

2. Rationale: It has been found that the current system is unintentionally focused on managing disabilities associated with mental illness rather than promoting recovery. It has been recommended that the focus be shifted to promoting recovery and building resilience by supporting the individual's ability to withstand stresses and life challenges such as through teaching stress management techniques. While vital to client safety, assessing the depressed client for suicidal ideations, sharing the client's wishes about the preferred form of medication, and discussing follow-up visits all focus on managing disabilities rather than promoting recovery and wellness.

Which statement made by a nurse interviewing a client who reports the fear that people are trying to poison him requires follow-up by the nurse's unit manager? 1. "Have other members of your family ever experienced this kind of thing?" 2. "Tell me more about how someone keeps trying to poison your food." 3. "How has this affected your ability to keep a job or care for yourself?" 4. "Let's discuss the stressors you have in your life right now."

2. Rationale: It is nontherapeutic to reinforce the delusion by encouraging the individual to focus on the details such as suggested in the correct option. The incorrect options do not reinforce the delusion. Rather, they help gain knowledge about the history of the disorder in the family, the extent of the dysfunction the fear is causing, and the triggers that may have resulted in this behavior.

The nurse is concerned that a depressed client may be displaying a nonverbal suicidal threat when he presents another client with his favorite shirt as a "gift." The nurse's initial intervention is to: 1. place the client on suicide precautions including 15-minute checks. 2. ask the client if he is experiencing suicidal ideations with a plan to hurt himself. 3. support the client by telling him that he will need the shirt when he's discharged. 4. document that the client has shown behaviors that are likely subtle suicide threats.

2. Rationale: Nonverbal suicide threats are generally indirect actions that a person is planning to take his or her own life such as in giving away prized possessions. Assessing the individual in a direct manner is the initial intervention in managing the risk for personal harm. Placing the client on suicide precautions is appropriate once the behavior has been identified as a suicide threat. Telling the client that he will need his shirt does not help identify whether the gesture is truly a suicide threat. Documentation is appropriate after the behavior has been identified as a suicide threat. The documentation as it is stated in the option is non-conclusive and subjective.

Which statement regarding behaviors of psychotic clients made by a float nurse requires follow-up by the mental health unit's nurse manager? 1. "It must be so frightening to be psychotic since no one else can understand what you are feeling." 2. "Psychotic individuals are difficult to manage since they are unpredictable and dangerous." 3. "You must monitor psychotic clients closely since they are at risk for hurting themselves." 4. "Individuals demonstrating psychotic tendencies are usually out of touch with reality."

2. Rationale: Psychosis refers to the mental state of not being in touch with reality. During an episode of psychosis, the person does not realize that others are not experiencing the same things and wonders why others are not reacting in the same way. One should be watchful but not assume the psychotic individual is unpredictable or dangerous. The statements in the incorrect options are true and do not require follow-up.

A nurse best engages in self-analysis that will benefit a specific nurse-client relationship when: 1. refraining from expressing any negative feelings about a client's behaviors. 2. asking, "What barriers exist that make it difficult for me to provide effective care for this client?" 3. reporting to the nurse manager that, "I've tried but I just can't work therapeutically with this client." 4. avoiding conflict with the client by seldom setting boundaries or disagreeing with his or her beliefs.

2. Rationale: Self-analysis is best reflected in the nurse's willingness to evaluate personal feelings about clients in order to first identify and then eliminate any barriers there may be to an effective therapeutic relationship. The nurse's role includes setting appropriate boundaries and exploring the possible causes of maladaptive or dangerous client behaviors. Asking for a change in assignments should occur only when all other attempts to manage barriers have failed. The nurse's role includes setting appropriate boundaries and exploring the possible causes of maladaptive or dangerous client behaviors.

The nurse best assures that a psychiatric client's rights are respected and preserved by: 1. educating each client as to his or her legally protected rights. 2. being knowledgeable of the state laws that regulate client rights. 3. participating as a member of the client's multidisciplinary health care team. 4. referring all issues of a legal nature to the appropriate facility committee.

2. Rationale: The legal context of care is important for all psychiatric nurses because it focuses concern on the rights of patients and the quality of care they receive. However, laws vary from state to state, and psychiatric nurses must become familiar with the laws of the state in which they practice. This knowledge enhances the freedom of both the nurse and the patient and ultimately results in legally appropriate care. While client education is an appropriate intervention, it cannot be done without first being knowledgeable of the client's legal rights. Though an appropriate intervention, participating on the health care team will not necessarily assure the preservation of client rights but rather holistic care. Though referring legal issues may be correct in some instances, it does not remove the nurse from being responsible for advocating for the client.

Which individual demonstrates the greatest risk for experiencing major depression? 1. A teenaged male who failed to make the football team 2. A young adult female who recently gave birth to her first child 3. An older adult female who retired after 25 years of factory work 4. A middle-aged male who is a self-employed small business owner

2. Rationale: The lifetime risk for major depression is 7% to 12% for men and 20% to 30% for women. Among women, rates peak between adolescence and early adulthood. It is particularly important to screen for depression among women of reproductive age, especially those who have children or plan to become pregnant. While the teenaged male and the retired female do present with risk for depression in the forms of disappointment and being a teenager, and retirement and being a female, there is an individual with several substantial risk factors. The middle-aged male's risk for major depression is relatively small.

Which statement made by a client demonstrates a prominent behavior related to noncompliance with prescribed treatment? 1. "I broke my hip last fall and it's still hard to get around." 2. "I have type 2 diabetes but I can still eat the way I always have." 3. "Weight has been a problem I've struggled with my entire adult life." 4. "My wife says I need to exercise if I'm ever going to get my blood pressure down."

2. Rationale: The most prominent behavior associated with noncompliance is refusal to admit the seriousness of the health problem. This denial interferes with acceptance of treatment such as maintaining a healthy diet for the treatment of type 2 diabetes. The broken hip statement, the statement about weight problems, and the comment about exercise show dissatisfaction, frustration, and lack of incentive with the state of health, but not a denial of the seriousness of the problem

A newly admitted client diagnosed with obsessive-compulsive disorder is exhibiting severe anxiety. Which intervention demonstrates that the nurse understands the principles related to the therapeutic management of this client? 1. The client is encouraged to talk about his rituals and how they help him manage his anxiety. 2. The nurse ignores the client's rituals so as to not interfere with his established coping mechanisms. 3. The client is asked to limit the number of times he performs his ritual to encourage control over his anxiety. 4. The nurse asks the client to explain why the rituals appear to relieve his anxiety in an attempt to have him reflect on his behavior.

2. Rationale: The severely anxious individual has not worked through the conflict causing his anxiety and so has no other coping mechanism to rely upon. Ignoring the behavior at this time in his therapy is therapeutic and does not cause additional stress. Drawing attention to his rituals would only serve to reinforce the behavior. Asking him to alter his rituals would be nontherapeutic as it would serve only to increase his stress. Attempting to explain his rituals would only serve to reinforce them and to increase his stress.

When attempting to substantiate a client's diagnosis of major depression the nurse: 1. assesses the client for signs of anorexia. 2. asks, "Have you ever been depressed like this before?" 3. assesses the client for behaviors associated with drug abuse. 4. asks, "Are you having any problems falling or staying asleep?"

2. Rationale: While most untreated episodes of major depression last 6 to 24 months, more than 50% of those who have one episode will eventually have another, and 25% of patients will have chronic, recurrent depression. While anorexia, drug abuse, and dysfunctional sleep patterns may be co-morbid conditions associated with depression, they are not strong risk factors for developing the disorder.

In order to address the potential risk for depression among a population, the nurse will: 1. provide a depression screening at a local afterschool program site. 2. present educational programming on depression to a senior citizen group. 3. routinely assess all chronically ill clients for depression during their admission interview. 4. include the signs of postpartum depression in the discharge packet for each new mother.

3. Rationale: A high incidence of depression is found among all patients hospitalized for medical illnesses. These depressions are largely unrecognized and untreated by general health care providers. Studies suggest that about one third of medical inpatients report mild or moderate symptoms of depression and up to one fourth may have major depression. Chronic medical conditions are often associated with depression. A depression screening is becoming more common since research suggests the incidence of depression in school age children is significant. Presenting educational programs on depression to senior citizens is becoming more common since research suggests the incidence of depression in the older adult is significant. Including depression information to new mothers is becoming more common since research suggests the incidence of depression in postpartum women is significant.

The psychiatric nurse best demonstrates an understanding of the general health challenges facing a mentally ill client who reports auditory hallucinations when asking: 1. "When did you first start hearing voices?" 2. "What did you have to eat last night for supper?" 3. "May I have your permission to take your blood pressure?" 4. "Do you understand why you need to take your medication?"

3. Rationale: A serious health problem is the higher rates of mortality and medical co-morbidity among patients who are mentally ill. Psychiatric patients experience high rates of a wide range of undiagnosed and untreated physical illnesses, including heart disease, diabetes, hypertension, cancer, and pulmonary illness. The psychiatric nurse needs to assess the client for such medical problems. "When did you first start hearing voices?" assesses the current mental health issue but does not address the client's general physical health. "What did you have to eat last night for supper?" assesses the client's access to food but does not address the client's general physical health. "Do you understand why you need to take your medication?" assesses the client's understanding of his treatment plan but does not address the client's general physical health.

Which statement demonstrates an expression of anxiety rather than fear? 1. "I can't stand spiders." 2. "You'd never get me on a roller coaster." 3. "I really dislike knowing that we have a 50-point test tomorrow." 4."I can't imagine why anyone would want to parachute out of an airplane."

3. Rationale: Anxiety is an emotion without a specific object that is provoked by the unknown or by new experiences. Being worried about a test is a common expression of anxiety. An intense dislike for spiders, roller coasters, and parachuting are fears since they are focused.

Which statement made by a mental health nurse demonstrates the need for further education regarding active listening as a therapeutic communication technique? 1. "When I use therapeutic silence, I'm giving the client time to think and reflect." 2. "Sharing perceptions doesn't mean I tell the client how my experiences are similar to his." 3. "I generally find it helpful to ask the client why he blames others for the mistakes he's made." 4. "It's not therapeutic to give the client suggestions as to what he needs to do to fix his problems."

3. Rationale: Asking why he is behaving in a particular manner is often viewed as judgmental by the client. Presenting such an attitude would be a barrier to communication and thus non-therapeutic. Stating, "When I use therapeutic silence, I'm giving the client time to think and reflect." describes an effective use of silence. Sharing perceptions is used to clarify an understanding of what the client is thinking or feeling. Suggestions are therapeutic only when given as possible alternatives for the client to consider, not when given as advice.

The greatest benefit derived from current work being done related to pharmacogenetics is that: 1. the cost of medication manufacturing will be drastically reduced. 2. research and development of new drugs will be much less costly. 3. medications will be designed so that they do not cause unwanted side effects. 4. medications will be formulated so that only one dose per day will be required.

3. Rationale: The new field of pharmacogenetics will eventually allow researchers to formulate drugs that will target the causes of a specific illness and so avoid non-illness targets in the body, thereby eliminating unwanted drug effects. The reduction in the cost of medication, in the cost of medication's research and development, or in the number of medication doses needed daily are not necessarily expected outcomes of the field of pharmacogenetics.

Words are powerful and language can stigmatize the individual dealing with mental illness. How can a nurse personally advocate for such individuals with this in mind? 1. Encouraging all clients to be aware of their communication so as to not offend others 2. Teaching the client diagnosed with schizophrenia to avoid pressured speech 3. Role modeling language that is respectful to those with mental illnesses 4. Engaging in communication that is always therapeutic

3. Rationale: Awareness of and changing personal language to avoid stereotypes and common negative references to the mentally ill is one form of personal advocacy. The role of advocate is focused on supporting and protecting the client. Encouraging clients to be cautious of their communication suggests that clients need to change in order to protect others from the effects of their speech. While teaching the client to avoid pressured speech has some therapeutic value, it is not an example of advocacy involving the power of one's own language on the person with mental illness. Therapeutic communication would not stigmatize a client who is mentally ill.

A client suspected of being schizophrenic is scheduled for a computed tomography (CT). The nurse informs the client that the diagnostic test will: 1. confirm the diagnosis of schizophrenia. 2. trace the flow of blood through his brain. 3. allow the doctors to view the structures of his brain. 4. help determine the areas of his brain that are overreacting.

3. Rationale: Computed tomography (CT) provides visualization of brain structures. It can detect enlargement of the cerebral ventricles—a characteristic seen in schizophrenia. No one diagnostic test would confirm a mental illness. PET, SPECT, and other functional magnetic resonance imaging (fMRI) techniques can measure the amount of blood flowing in a region of the brain (regional cerebral blood flow). Techniques that show brain function include positron emission tomography (PET), which measures brain activity.

The client's chart indicates that she has experienced trauma to the cerebral cortex as a result of injuries sustained during an attempted suicide. Which observation is most likely the result of this injury? 1. Client is often found crying into her pillow. 2. Client demonstrates involuntary twitching of facial muscles. 3. Client states, "What do you mean 'it's raining cats and dogs'?" 4. Client asks, "Can you address this letter to my mom; I forget her address?"

3. Rationale: Damage to the cerebral cortex may hinder the ability to think abstractly resulting in the client's failure to understand the phrase "it's raining like cats and dogs." Crying is a characteristic of sadness or depression that results from altered serotonin levels rather than trauma to the cerebral cortex. Involuntary muscle contraction is a characteristic of trauma to the basal ganglia rather than trauma to the cerebral cortex. Memory loss results from damage to the limbic system rather than trauma to the cerebral cortex.

The nurse bases initial care of a client relying heavily on denial as a mechanism for coping with the diagnosis of cancer in her 12-year-old daughter on the principle that: 1. the mother must accept the diagnosis in order to provide the daughter with the care she needs. 2. it will be best to help the mother substitute another defense mechanism so that she can begin to accept the diagnosis. 3. no attempts should be made to make the mother accept the diagnosis until she has been able to confront the stress of the diagnosis. 4. the severity of the diagnosis is more than the mother can handle and she will likely permanently rely on denial as a coping mechanism.

3. Rationale: It is important not to confront the basic conflict that is leading to stress and anxiety without sufficient support and coping alternatives. Premature attempts to convince the person of psychological conflicts may result in the use of a less adaptive coping mechanism. In extreme cases, if the person is stripped of all efforts to cope and not provided with a substitute, death can result, either from worsening of the organic disorder or from suicide. The pressure to accept the diagnosis prematurely is likely to result in dangerous levels of stress for the mother. The pressure to substitute defense mechanisms is premature and likely to intensify the stress. With the proper support, the mother is likely to regain her ability to face the diagnosis and support her daughter appropriately.

The nurse is managing the care of an older adult diagnosed with bipolar disorder who is in a manic phase. The nurse closely monitors the client for risks to his safety. This intervention is especially appropriate for this client because: 1. older adults experience physical conditions that greatly increase the potential for injury. 2. the manic phase will be followed by a phase of severe depression. 3. mania can result in irresponsible and physically risky behaviors. 4. such a client is easily abused by other aggressive clients.

3. Rationale: Patients in the manic phase of bipolar disorder may have misperceptions about their power and importance and involve themselves in senseless, irresponsible, and risky activities that can result in physical harm. While it is true that older adults are at risk for injury related to both acute and chronic illness, that depression generally follows mania, and that manic individuals are at risk for injury caused by those who are affected by or who misunderstand the behavior, the primary risk to this client comes from the manic behavior itself.

Which statement supports the nurse's suspicions that the client is experiencing low self- esteem? 1. "Going back to college at my age is really hard." 2. "I've had to work hard for everything I've ever gotten." 3. "The really stylish clothes just don't look good on my body." 4. "I wish I was more comfortable speaking to a crowd of people."

3. Rationale: People who accept their bodies are more likely to have high self-esteem than people who dislike their bodies. The statement about going back to college acknowledges a challenge; there is no reason to assume the individual feels incapable of being successful just that it is hard work. "I've had to work hard for everything I've ever gotten." is a statement is one of fact; there is reason to believe the individual has earned "things" and so there is no reason to assume low self-esteem. The statement concerning speaking to a crowd expresses a wish for something different from what exists; it infers that the client can speak in front of a crowd but wishes it were comfortable and so there is no reason to assume low self-esteem.

The care plan of a client diagnosed with personality fusion includes the nursing diagnosis of situational low self-esteem. Which assessment data best supports this nursing diagnosis for this client? 1. Reports the need to lose 50 pounds 2. Was orphaned at age 5 and lived in foster homes 3. Expresses a fear of living alone when her mother dies 4. Has been in a verbally abusive relationship for nearly 18 years

3. Rationale: Personality fusion is a person's attempt to establish a sense of self by fusing with, attaching to, or belonging to someone else. Situational low self-esteem is related to doubts about self and her abilities, as evidenced by expressed fears of living alone, finding a job, and getting along with people. The statement about weight reduction may be an unhealthy statement related to poor body image. The information regarding being orphaned focuses on the possibility of poor emotional development related to childhood traumas. The issue concerning an abusive relationship focuses on the possibility of poor self-esteem but is related to chronic abuse not personality fusion.

In order to best support improvement in an anxious individual's sense of control and competence, the nurse: 1. provides lavish amounts of praise when the individual accomplishes assigned tasks. 2. educates the individual regarding the usefulness of stress management techniques. 3. helps the individual identify several stress situations that he was successful in managing. 4. has the individual describe how one demonstrates control and competence over stress.

3. Rationale: Positive self-concepts result from positive experiences leading to perceived competence and acceptance. Assisting the client in identifying such situations will aid in building his confidence and his perception of being competent. Being praised for successes is appropriate, but it must be reserved for situations that the individual recognizes as meaningful. While stress management techniques are important to the management of stress, they are not directly linked to a sense of competence as is another available option. Describing how one demonstrates control and competence is applicable, but it has limited favor in actually assisting the client in feeling competent.

A distinguishing factor of psychosis is that it: 1. is caused by moderate to severe anxiety. 2. incorporates delusions into an individual's reality. 3. results in a significant misrepresentation of what is real. 4. is dependent on an individual's baseline cognitive function.

3. Rationale: Psychosis is disintegrative and involves a significant distortion of reality. Psychosis emerges with the panic level of anxiety. Delusional thinking may not be demonstrated by all psychotic individuals. Cognitive function is not a predisposing factor for the development of psychosis.

An Asian-American client has been prescribed an antidepressant medication for severe depression. When the nurse prepares discharge teaching topics for this client, which specific information will be included? 1. The Asian culture is traditionally resistant to the use of antidepressant medication and so the importance of compliance with the prescribed treatment plan is stressed. 2. Ethnic Asian foods have been shown to cause poor absorption of many medications and so the antidepressant medication should be taken on an empty stomach. 3. Some racial and ethnic groups are genetically predisposed to enzyme deficiencies that require that their medications be prescribed at lower than normal dosages. 4. Antidepressants can take weeks to reach the therapeutic blood serum levels required for the symptoms of severe depression to demonstrate improvement.

3. Rationale: Some racial and ethnic groups have genetic predispositions toward deficiencies in some metabolic enzymes, making them at greater risk for CYP-450 problems such as increased side effects and even toxicity when medications are prescribed at normal dosages. The statement about the Asian culture is not necessarily true; generalizations should not be made regarding any ethnic group since individual beliefs and practices can vary greatly. There is no current research to support the statement regarding Asian foods. The statement about antidepressants taking weeks to reach therapeutic levels is a true statement, but it is true in general and not specific to Asian-Americans being prescribed this classification of medications.

A client diagnosed with depression has reported fatigue and poor concentration. When she is told that the results of her sleep study show that she has excessive REM sleep cycles, the client asks the nurse to explain what those results mean. The nurse best answers the client's concerns by replying: 1. "It means that you are sleep deprived." 2. "REM sleep stands for rapid eye movement sleep." 3. "Too much REM sleep deprives you of deep restoring sleep." 4. "Depressed individuals generally experience prolonged periods of REM sleep."

3. Rationale: Studies show that in depressed persons, REM sleep is excessive, the deeper stages of sleep are decreased, and dreams may be unusually intense. Thus, although they may sleep 6 to 9 hours each night, people with depression frequently report fatigue, poor concentration, and irritability associated with sleep deprivation. While the incorrect statements are true, they do not fully explain the importance of excessive REM cycle sleep to the client.

According to the World Health Organization study, which nursing activity addresses the number one psychiatric cause of disability in the world today? 1. Arranging for a client's transportation to Alcoholics Anonymous meetings 2. Helping the family understand their mother's obsessive-compulsive disorder 3. Offering a depression screening at a local school for students in grades 8 through 12 4. Providing nursing care at a free clinic that serves the schizophrenic population in a large city

3. Rationale: The World Health Organization's (WHO) global burden of disease study revealed that mental disorders are the second most disabling category of illnesses around the world. The data showed that depression was the number one psychiatric cause of disability in the world. Alcohol abuse, obsessive-compulsive disorder, and schizophrenia were identified among the top 10 causes of disability in the world.

When a firefighter who works long shifts is seen in the emergency department four times in a 6-week period for treatment for accident-related injuries, the nurse asks: 1. "Do you consider yourself easily distracted?" 2. "When did you last have your eyes checked?" 3. "Are you experiencing any problems sleeping?" 4. "Can you explain to me why you are so accident prone?"

3. Rationale: The consequences of sleep disorders, sleep deprivation, and sleepiness are significant. They can result in higher morbidity and mortality risks including an increase in injuries related to accidents. While being easily distracted and possibly having eye problems may be factors, the individual's work schedule puts him at risk for sleep-related problems. The question concerning the firefighter being accident prone is accusatory and likely to be a barrier to effective communication.

Which nursing statement describes the basis of the ethical theory called utilitarianism? 1. "The client has a right to make decisions based on what he wants and needs." 2. "Every client deserves the care that I would want if I were in his situation." 3. "I can't allow a client to smoke in the day room since it isn't healthy for the other clients." 4. "The homeless need access to quality mental health care just as much as any other group."

3. Rationale: Utilitarianism focuses on the consequences of actions. It seeks the greatest amount of happiness or the least amount of harm for the greatest number, or "the greatest good for the greatest number." Since smoking benefits only the smoker and can be dangerous to the others on the unit, it is not allowed. Egoism is a position in which the individual seeks the solution that is best personally. Oneself is most important, and others are secondary. Formalism considers the nature of the act itself and the principles involved. It involves the universal application of a basic rule, such as "do unto others as you would have them do unto you." Fairness is based on the concept of justice, and benefit to the least advantaged in society becomes the norm for decision-making.

Which nurse-focused action demonstrates an understanding of the importance of value clarification to the therapeutic relationship between nurse and client? 1. Intently listening while the client describes physical abuse she was exposed to as a child 2. Offering to arrange for the hospital chaplain to visit a client who is severely depressed 3. Asking a client to explain his or her cultural beliefs regarding the role of women 4. Encouraging the client to read a newspaper article that debates various political issues

3. Rationale: Values learned from various life experiences are influenced by one's cultural history and beliefs. In order to understand and accept a client's belief, the nurse must understand his or her culture. While appropriate, as an example of "being available in the moment" to the client, the past experiences of physical abuse do not have relevance regarding value clarification. Arranging for the chaplain to visit may support a value but only when the request is initiated by the client and not the nurse. Encouraging such activities as reading articles that discuss various points of view will help broaden a client's knowledge but has little effect on clarifying existing values.

Which statement describes the basis of an ethical dilemma? 1. "It's so difficult when the client doesn't agree with the treatment team." 2. "The client insists on behaving in a manner that will likely cause him injury." 3. "It's difficult to determine who makes decisions for an incompetent client without a medical surrogate." 4. "There are only two treatment choices; both are very painful and neither has a high rate of success."

4. Rationale: An ethical dilemma exists when a choice must be made between equally unsatisfactory alternatives. A disagreement does not by itself qualify as an ethical dilemma. The cognitive client has the right to engage in risky behaviors as long as they don't endanger others; so no ethical dilemma exists. While decision making for an incompetent client is difficult and may even be a legal issue, such situations are seldom considered ethical dilemmas.

The nurse documents that a client is demonstrating a negative symptom of schizophrenia when observing the client: 1. refusing to eat anything that is not tasted by the staff first. 2. reporting hearing voices telling him that the world will end soon. 3. communicating using a pattern of speech identified as "word salad." 4. having difficulty focusing on any task for more than a few minutes.

4. Rationale: Attention impairment is considered a negative symptom since it represents a diminution or loss of normal brain function. Paranoia, hallucinations, and distorted speech are considered positive symptoms since they are an exaggeration or distortion of normal brain function.

Which individual has not met the criteria for involuntary commitment to a mental health facility? 1. A teenager who has threatened to shoot himself if his girlfriend leaves him 2. A young adult who is 20% below normal weight as a result of dramatically restricting food 3. An older adult found wandering in the mall who is unable to provide his name 4. An adult who reports that he drinks way too much in order to forget the abuse he's endured

4. Rationale: Most state laws permit involuntary commitment of the mentally ill if they are a true danger to themselves or others, are mentally ill and in need of treatment, or are unable to provide for their own basic needs. While drinking too much to forget incidences of abuse is an indication of a need for mental health treatment, it is not severe enough to qualify for involuntary admission. Most state laws permit involuntary commitment of the mentally ill if they are a true danger to themselves or others as in a suicide threat, as being voluntarily malnourished, or if they are unable to provide for their own basic needs such as in the case of a disoriented individual.

An older adult client has been asked to participate in a randomized controlled trial (RCT) related to the development of a new psychotropic medication. The nurse responsibly acts as the client's advocate when: 1. reassuring the client that the process of RCTs is a perfectly safe one. 2. explaining to the client the possible risks involved in participating in this particular RCT. Incorrect 3. educating the client's family concerning the details of participating in such a medication- focused RCT. 4. assessing the degree of understanding the client has about what a medication-focused RCT will involve.

4. Rationale: Nurses involved in psychopharmacological randomized controlled trials (RCTs) advocate for their clients by being sure that the individual client understands the concepts of informed consent, double-blind randomization, experimental treatments, placebo-controlled trials, and their patient rights. It is not appropriate to assure the client of any outcome that is not within the nurse's control. Explaining possible risks is the responsibility of the health care professional controlling the trial not the nurse. Educating the client's family is not a nursing responsibility in this situation; reinforcing education may be appropriate if the client has allowed his family to be involved in this situation.

Which statement is most concerning regarding a depressed client's state of mind? 1. "I just want to go to sleep and not wake up." 2. "When I get out of here I'm going to kill myself." 3. "I'm so tired of living like this; I want it to be over." 4. "Shooting myself with dad's gun will end it all quickly."

4. Rationale: The most suicidal person is the one who has a plan that is lethal, specific, and available. This option presents a plan that is specific, lethal, and available to the individual. The statements about going to sleep and not waking up and about being tired living a certain way demonstrate wishes, not a specific, lethal plan that the individual can implement. The statement "When I get out of here I'm going to kill myself." lacks a specific plan as to how the threat will be carried out.

The nurse is confident that an individual possesses a healthy sense of identity when hearing the individual state: 1. "I have my mother's blue eyes." 2. "My wife says I'm a really good father to our son." 3. "My father loved horses; I have two horses of my own." 4. "I'm good at jigsaw puzzles; let's work together on this one."

4. Rationale: The person with a positive sense of identity sees himself as a unique and valuable individual. The statement about the person's mother demonstrates a relationship to family. The statement concerning being a good father demonstrates a healthy adjustment to an expected role. The statement about horses demonstrates a healthy sense of accomplishment.

Which of the following actions demonstrates that the nurse has an understanding of the impact that continued advancements in psychopharmacology has on both client outcomes and professional psychiatric nursing practice? 1. Working towards achieving advanced practice nursing credentials in psychiatric nursing 2. Stressing the importance of medication therapy compliance with each client upon discharge 3. Participating in interdisciplinary treatment teams as a means of staying current regarding the latest clinical treatments and guidelines 4. Accessing information on the best evidence-based practices regarding the psychopharmacology medications being prescribed to his or her clients

4. Rationale: The psychiatric nurse should make use of the best evidence and current clinical guidelines to stay up to date on emerging theories and treatments for psychiatric illnesses. While all of the information in the incorrect options is appropriate, the key is staying aware of the current clinical research and practices related to psychopharmacology.

The only class of commonly abused drugs that has a specific antidote is the a. opiates. b. hallucinogens. c. amphetamines. d. benzodiazepines.

A

Reaction formation

A complete opposite expression of your inward feeling (e.g., arguing all the time with someone you are attracted to when your feelings are not known)

Identification

A defense mechanism that helps deal with feelings of threat and anxiety by enabling us unconsciously to take on the characteristics of another person who seems more powerful or better able to cope.

A young woman reports that although she has no memory of the event, she believes that she was raped. This raises suspicion that she unknowingly ingested a. LAAM b. GHB c. ReVia d. Clonidine

B

Undoing

Communication or behavior done to negate a previously unacceptable act

Suppression

Conscious, intentional pushing of unpleasantness from one's mind

Rationalization

Creating false but plausible excuses to justify unacceptable behavior.

Sublimation

Dealing with unacceptable feelings or impulses by unconsciously substitute acceptable forms of expression

Projection

Defense mechanism by which people attribute their own undesirable traits to others.

Denial

Defense mechanism by which people refuse to accept reality.

intellectualization

Excessive reasoning or logic used to avoid experiencing disturbing feelings.

Introjection

Incorporation of values or qualities of an admired person or group into one's own ego structure

Displacement

Psychoanalytic defense mechanism that shifts sexual or aggressive impulses toward a more acceptable or less threatening object or person, as when redirecting anger toward a safer outlet.

Dissociation

defense mechanism that involves the separation of oneself from one's experiences

Splitting

viewing people and situations as either all good or all bad

Blurring of boundaries

when a professional relationship starts to become personal