MH1

The question that would give data of least value to the assessment of family dynamics is

"Do you expect others to shun or avoid you because you are seeing a therapist?" -- The question about others' reaction to seeking help from a psychotherapist will not provide data about family dynamics.

A peer asks you to help him differentiate between culture and ethnicity for clarification. Which statement by the peer would acknowledge that you had appropriately helped him clarify the difference between the two terms? "So, ethnicity refers to shared history and heritage, whereas culture refers to sharing the same beliefs and values."

"So, ethnicity refers to shared history and heritage, whereas culture refers to sharing the same beliefs and values." --Ethnicity is sharing a common history and heritage. Culture comprises the shared beliefs, values, and practices that guide a group's members in patterned ways of thinking and acting. The other options are all incorrect definitions of ethnicity and culture.

The nurse assesses the wellness beliefs and values of a client from another culture best when asking

"What do you think is making you ill?" -- Asking the client to suggest reasons for the illness will best provide an opportunity to become familiar with general beliefs and values the client holds regarding his wellness.

Which assessment question would produce data that would help a nurse understand healing options acceptable to a client

"What usually helps people who have the same type of illness you have?" --Asking about typical treatment seeks information about the "usual" cultural treatment of the disorder experienced by the client.

You are working on the psychiatric unit and assisting with the care for Mr. Tran, a refugee from Darfur, who came to the United States 1 year ago. Although Mr. Tran understands and speaks some very limited English, he is much more comfortable conversing in his native language. Mike, the nurse working directly with Mr. Tran, says to you, "I am so frustrated trying to communicate with Mr. Tran! He insists on speaking his language instead of English. I think if people want to live here, they ought to have to speak our language and act like we do!" Which of the following responses you could make promotes culturally competent care? (BOTH ARE CORRECT) "What you are saying is actually considered cultural imposition, which is imposing our own culture onto someone from a different culture." "Mr. Tran's ability to speak and understand English is very limited. He needs to have an interpreter to make sure he can make his needs and feelings known."

"What you are saying is actually considered cultural imposition, which is imposing our own culture onto someone from a different culture." Correct "Mr. Tran's ability to speak and understand English is very limited. He needs to have an interpreter to make sure he can make his needs and feelings known." Correct -- Cultural imposition is imposing our own cultural norms onto those from another cultural group. By obtaining an interpreter for Mr. Tran, the nurse is promoting culturally competent care, ensuring the patient can communicate his feelings and needs thoroughly to the staff. Patients do have a right to an interpreter, but stating that Mike is right is not promoting culturally competent care and is instead confirming his opinion. Asking family members to convince the patient to speak English is not promoting culturally competent care and also undermines the trust between nurse and patient. Instead of encouraging the patient to speak English an interpreter should be obtained for the patient.

A psychiatric nurse best applies the ethical principle of autonomy by: A.exploring alternative solutions with a patient, who then makes a choice. B.suggesting that two patients who were fighting be restricted to the unit. C.intervening when a self-mutilating patient attempts to harm self. D.staying with a patient demonstrating a high level of anxiety.

A Autonomy is the right to self-determination, that is, to make one's own decisions. By exploring alternatives with the patient, the patient is better equipped to make an informed, autonomous decision. The distracters demonstrate beneficence, fidelity, and justice.

A patient in alcohol rehabilitation reveals to the nurse, "I feel terrible guilt for sexually abusing my 6-year-old before I was admitted." Select the nurse's most important action. A. Anonymously report the abuse by phone to the local child protection agency B. Reply, "I'm glad you feel comfortable talking to me about it." C. File a written report with the agency's ethics committee. D. Respect nurse-patient relationship confidentiality.

A Laws regarding child abuse reporting discovered by a professional during the suspected abuser's alcohol or drug treatment differ by state. Federal law supersedes state law and prohibits disclosure without a court order except in instances in which the report can be made anonymously or without identifying the abuser as a patient in an alcohol or drug treatment facility.

A nurse is concerned that an agency's policies are inadequate. Which understanding about the relationship between substandard institutional policies and individual nursing practice should guide nursing practice? A. Agency policies do not exempt an individual nurse of responsibility to practice according to professional standards of nursing care. B. Agency policies are the legal standard by which a professional nurse must act and therefore override other standards of care. C. Faced with substandard policies, a nurse has a responsibility to inform the supervisor and discontinue patient care immediately. D. Interpretation of policies by the judicial system is rendered on an individual basis and therefore cannot be predicted.

A Nurses are professionally bound to uphold standards of practice regardless of lesser standards established by a health care agency or a state. Conversely, if the agency standards are higher than standards of practice, the agency standards must be upheld. The courts may seek to establish the standard of care through the use of expert witnesses when the issue is clouded.

In order to release information to another health care facility or third party regarding a patient diagnosed with a mental illness, the nurse must obtain: A. a signed consent by the patient for release of information stating specific information to be released. B. a verbal consent for information release from the patient and the patient's guardian or next of kin. C. permission from members of the health care team who participate in treatment planning. D. approval from the attending psychiatrist to authorize the release of information.

A Nurses have an obligation to protect patients' privacy and confidentiality. Clinical information should not be released without the patient's signed consent for the release.

A person in the community asks, "Why aren't people with mental illness kept in state institutions anymore?" Select the nurse's best response. A. "Less restrictive settings are available now to care for individuals with mental illness." B. "There are fewer persons with mental illness, so less hospital beds are needed." C. "Most people with mental illness are still in psychiatric institutions." D. "Psychiatric institutions violated patients' rights."

A The community is a less restrictive alternative than hospitals for treatment of persons with mental illness. The distracters are incorrect and part of the stigma of mental illness.

Insurance will not pay for continued private hospitalization of a mentally ill patient. The family considers transferring the patient to a public hospital but expresses concern that the patient will not get any treatment if transferred. Select the nurse's most helpful reply. A. "By law, treatment must be provided. Hospitalization without treatment violates patients' rights." B. "All patients in public hospitals have the right to choose both a primary therapist and a primary nurse." C. "You have a justifiable concern because the right to treatment extends only to provision of food, shelter, and safety." D. "Much will depend on other patients, because the right to treatment for a psychotic patient takes precedence over the right to treatment of a patient who is stable."

A The right to medical and psychiatric treatment was conferred on all patients hospitalized in public mental hospitals with the enactment of the federal Hospitalization of Mentally Ill Act in 1964.

Which of the following statements indicate a nontherapeutic communication technique? (select all that apply): A. "Why didn't you attend group this morning?" B. "From what you have said, you have great difficulty sleeping at night." C. "What did your boyfriend do that made you leave? Are you angry at him? Did he abuse you in some way?" D. "If I were you, I would quit the stressful job and find something else." E. "I'm really proud of you for the way you stood up to your brother when he visited today." F. "You mentioned that you have never had friends. Tell me more about that." G. "It sounds like you have been having a very hard time at home lately."

A, C, D, E All these options reflect the nontherapeutic techniques of (in order) asking "why" questions; using excessive questioning; giving advice; and giving approval. The other options describe therapeutic techniques of restating, exploring, and reflecting.

Which of the following statements are true regarding the differences between a social relationship and a therapeutic relationship? (select all that apply): A. In a social relationship, both parties' needs are met; in a therapeutic relationship only the patient's needs are to be considered. B. A social relationship is instituted for the main purpose of exploring one member's feelings and issues; a therapeutic relationship is instituted for the purpose of friendship. C. Giving advice is done in social relationships; in therapeutic relationships giving advice is not usually therapeutic. D. In a social relationship, both parties come up with solutions to problems and solutions may be implemented by both (a friend may lend the other money, etc.); in a therapeutic relationship solutions are discussed but are only implemented by the patient. E. In a social relationship, communication is usually deep and evaluated; in a therapeutic relationship communication remains on a more superficial level, allowing patients to feel comfortable.

A,C,D The other options describe the opposite meanings of social and therapeutic relationships.

A 14-year-old belongs to a neighborhood gang, engages in sexually promiscuous behavior, and has a history of school truancy but reports that her parents are just old- fashioned and don't understand her. The assessment data supports that the client A. is displaying deviant behavior. B. cannot accurately appraise reality. C. is seriously and persistently mentally ill. D. should be considered for group home placement.

A. This client is demonstrating deviant behavior. This client demonstrates undersocialized, aggressive behavior such as a repetitive and persistent pattern of aggressive conduct in which the basic rights of others are violated.

The medication prescribed for a client acts by blocking reuptake of both serotonin and norepinephrine. The nurse evaluates the treatment as successful when observing A. laughing at a joke. B. exercising a sore shoulder. C. writing down his telephone number. D. going to his room to "calm down."

A. Depression is thought to be at least in part caused by lowered levels of serotonin and norepinephrine. Increasing the amount of these transmitters in the brain by blocking reuptake may result in mood elevation.

The nurse caring for a client taking risperidone (Risperidal) observes the client carefully for A. napping during the day, a weight gain, and reports of dizziness. B. reports of falls, heartburn, and nausea. C. a rapid heartbeat, red rash, and hives. D. dry mouth, poor urinary output, and constipation.

A. H1 blockade has the potential to produce sedation, weight gain, and hypotension.

The basic functional unit of the nervous system is called a A. neuron. B. synapse. C. receptor. D. neurotransmitter.

A. Neurons are nerve cells. Cells are the basic unit of function. A neurotransmitter is a chemical substance that functions as a neuromessenger. This neurotransmitter then diffuses across a space, or synapse, to an adjacent postsynaptic neuron, where it attaches to receptors on the neuron's surface.

Cells that respond to stimuli, conduct electrical impulses, and release neurotransmitters are called A. neurons. B. synapses. C. dendrites. D. receptors.

A. Neurons are the basic functional unit of the nervous system responsible for sending and receiving messages as electrochemical events.

You are caring for Vanessa, a 38-year-old patient with major depression. She has just met with her provider. She states to you, "my provider said something about the medicine she is ordering working on my neurotransmitters. What exactly are neurotransmitters?" Your best response is: A. "Neurotransmitters are chemical messengers in the brain that help regulate specific functions." B. "Neurotransmitters are too complicated to explain easily. Just know that the medication will help your mood." C. "Neurotransmitters are the reason you are depressed." D. "I will ask your provider to give you a more in-depth explanation."

A. Neurotransmitters are chemicals released from neurons that function as a neuromessenger and influence brain functions. Telling the patient that the answer is too complicated belittles the patient by implying she cannot understand, while stating that neurotransmitters are the reason she is depressed is too simplistic. Asking the provider to give the education abdicates your responsibility to provide patient education.

The nurse planning care for a mentally ill client bases interventions on the concept that the client A. has areas of strength on which to build. B. has right that must be respected. C. comes with experiences that contribute to their problem. D. share fears that are similar to those of all mentally healthy individuals.

A. Nurses are expected to evaluate clients with mental health issues for their strengths and their areas of high functioning. You will find many attributes of mental health in some of your clients with mental health issues. These strengths should be built upon and encouraged.

Treatment of mental illnesses with psychotropic drugs is directed at A. altering brain neurochemistry. B. correcting brain anatomical defects. C. regulating social behaviors. D. activating the body's normal response to stress.

A. Psychotropic drugs act to increase or decrease neurotransmitter substances within the brain, thus altering brain neurochemistry.

Which statement best describes the DSM-5? a. It is a medical psychiatric assessment system. b. It is a compendium of treatment modalities. c. It offers a complete list of nursing diagnoses. d. It suggests common interventions for mental disorders.

A. The DSM-5 is a classification of mental disorders that includes descriptions and criteria of diagnoses.

A client's communication is marked by loose associations and word salad. Dysfunction of which portion of the brain is responsible for these symptoms? A. Cerebrum B. Cerebellum C. Brainstem D. Basal ganglia

A. The ability to think and speak logically is controlled by the cerebrum.

Current information suggests that the most disabling mental disorders are the result of a. biological influences. b. psychological trauma. c. learned ways of behaving. d. faulty patterns of early nurturance.

A. The biologically influenced illnesses include schizophrenia, bipolar disorder, major depression, obsessive-compulsive and panic disorders, posttraumatic stress disorder, and autism. Therefore many (but not all) of the most prevalent and disabling mental disorders have been found to have strong biological influences. Psychological trauma, learned behaviors, and faulty patterns of nurturance may contribute to some forms of mental illness, but they are not major factors in most disabling mental disorders.

When a tumor of the cerebellum is present, the nurse should expect that the client would initially demonstrate A. disequilibrium. B. abnormal eye movement. C. impaired social judgment. D. blood pressure irregularities.

A. The cerebellum is the organ primarily responsible for symptoms of equilibrium or imbalance.

The incoherent thought and speech patterns of the client with schizophrenia are related to the brain's inability to A. regulate conscious mental activity. B. retain and recall past experience. C. regulate social behavior. D. maintain homeostasis.

A. When the brain cannot regulate conscious mental activity, the individual's speech patterns demonstrate incoherence and lack of reality orientation.

You are admitting 32-year-old Louisa to the psychiatric unit. You pull up your chair and sit close to the patient, with your knees almost touching hers, and lean in close to her to speak. Louisa becomes visibly flustered and gets up and leaves the room. What is the most likely explanation for Louisa's behavior? A. You have violated Louisa's personal space by physically being too close. B. Louisa has issues with sharing personal information. C. You have not made the patient feel comfortable by explaining the purpose of the admission interview. D. Louisa is responding to the voices in her head telling her to leave.

A. By sitting and leaning in so closely, you have entered into intimate space (0 to 18 inches), rather than social distance and the patient may feel uncomfortable with being so close to someone she does not know. All the other options lack evidence and jump to conclusions regarding the patient's behavior.

Two main principles that can guide the communication process during the nurse-client interview are A. clarity and giving recognition. B. personal and environmental factors. C. passive listening and cultural caution. D. interpreting and speculating on the client's meaning.

A. Clarity refers to mutual understanding of communication, and giving recognition indicates awareness of change and personal efforts. Both are desirable.

What is the focus during clinical supervision? A. The nurse's behavior in the nurse-client relationship B. Analysis of the client's motivation for transferences C. Devising alternative strategies for client growth D. Assisting the client to develop increased independence

A. Clinical supervision helps the nurse look at his or her own behavior and determine more effective approaches to working with clients.

You are caring for Kiley, a 29-year-old female patient who is being admitted following a suicide attempt. Which of the following illustrates the concept of patient advocacy?

A. "Dr. Raye, I notice you ordered Prozac for Kiley. She has stated to me that she does not want to take Prozac because she had adverse effects when it was previously prescribed." B. "Dr. Raye, during her admissions interview Kiley stated that she has had three other suicide attempts in the past." C. "Kiley, can you tell me more about your depression and your suicide attempt?" D. "Kiley, I will take you on a tour of the unit and orient you to the rules." A. By letting the provider know that the patient does not want the treatment the provider is prescribing, you have advocated for the patient and her right to make decisions regarding her treatment. The other selections do not describe patient advocacy.

A nurse who is active in local consumer mental health groups and in local and state mental health associations and who keeps aware of state and national legislation affecting mental illness treatment may positively affect the climate for treatment by:

A. becoming active in politics leading to a potential political career. B. reducing the stigma of mental illness and advocating for equality in treatment. C. encouraging laws that would make the involuntary long-term commitment process easier and faster for caregivers of mentally ill persons. D. advocating for reduced mental health insurance benefits to discourage abuse of the system by inappropriate psychiatric admissions. B. Nurses who are aware of legislative concerns and who are active in organizations that promote mental health awareness and appropriate and equal treatment for mental illness help achieve the goal of parity, or equality of treatment for mentally ill individuals. Becoming active in politics may be a personal goal but does not directly or necessarily reduce stigma or encourage treatment equality. The other options are undesirable outcomes.

According to the DSM-5, there is evidence that symptoms and causes of mental illness are influenced by:

A. cultural and ethnic factors. B. occupation and status. C. birth order. D. sexual preference. A. The DSM-5 states there is evidence to suggest that mental illness is influenced by cultural and ethnic factors. The DSM-5 does not state that there is evidence that occupation, birth order, or sexual preference affect mental illness.

An individual is found to consistently wear only a bathrobe and neglect the cleanliness of his apartment. When neighbors ask him to stop his frequent outbursts of operatic arias, he acts outraged and tells them he must sing daily and will not promise to be quieter. This behavior supports that he is

A. demonstrating symptoms of bipolar disorder. B. socially deviant. C. egocentric. D. not demonstrating any definitive signs of mental illness. D. One myth about mental illness is that to be mentally ill is to be different and odd. Another misconception is that to be healthy, a person must be logical and rational. Everyone dreams "irrational" dreams at night, and "irrational" emotions are universal human experiences and are essential to a fulfilling life. Some people who show extremely abnormal behavior and are characterized as mentally ill are far more like the rest of us than different from us. No obvious and consistent line between mental illness and mental health exists.

One characteristic of mental health that allows people to adapt to tragedies, trauma, and loss is:

A. dependence. B. resilience. C. pessimism. D. altruism. B. Resilience is a characteristic that helps individuals cope with loss and trauma that may occur in life. Dependence is described as being dependent on others for decision making and care. Pessimism is a life philosophy that things are more likely to go wrong than right. Altruism is described as putting others before yourself.

The nurse responsible for the care of a client prescribed clonazepam (Klonopin) would evaluate treatment as being successful when the client demonstrates A. less anxiety. B. normal appetite. C. improved sleep pattern. D. reduced auditory hallucinations.

A. less anxiety γ-Aminobutyric acid is thought to modulate neuronal excitability and anxiety. A drug that increases the effectiveness of γ-aminobutyric acid would result in anxiety reduction.

A patient diagnosed with major depression has lost 20 pounds in one month, has chronic low self-esteem, and a plan for suicide. The patient has taken an antidepressant medication for 1 week. Which nursing intervention has the highest priority? a. Implement suicide precautions. b. Offer high-calorie snacks and fluids frequently. c. Assist the patient to identify three personal strengths. d. Observe patient for therapeutic effects of antidepressant medication.

ANS: A Implementing suicide precautions is the only option related to patient safety. The other options, related to nutrition, self-esteem, and medication therapy, are important but are not priorities.

When a nurse assesses an older adult patient, answers seem vague or unrelated to the questions. The patient also leans forward and frowns, listening intently to the nurse. An appropriate question for the nurse to ask would be: a. "Are you having difficulty hearing when I speak?" b. "How can I make this assessment interview easier for you?" c. "I notice you are frowning. Are you feeling annoyed with me?" d. "You're having trouble focusing on what I'm saying. What is distracting you?"

ANS: A The patient's behaviors may indicate difficulty hearing. Identifying any physical need the patient may have at the onset of the interview and making accommodations are important considerations. By asking if the patient is annoyed, the nurse is jumping to conclusions. Asking how to make the interview easier for the patient may not elicit a concrete answer. Asking about distractions is a way of asking about auditory hallucinations, which is not appropriate because the nurse has observed that the patient seems to be listening intently.

A nurse performing an assessment interview for a patient with a substance use disorder decides to use a standardized rating scale. Which scales are appropriate? Select all that apply. a. Addiction Severity Index (ASI) b. Brief Drug Abuse Screen Test (B-DAST) c. Abnormal Involuntary Movement Scale (AIMS) d. Cognitive Capacity Screening Examination (CCSE) e. Recovery Attitude and Treatment Evaluator (RAATE)

ANS: A, B, E Standardized scales are useful for obtaining data about substance use disorders. The ASI, B-DAST, and RAATE are scales related to substance abuse. AIMS assesses involuntary movements associated with anti-psychotic medications. The CCSE assesses cognitive function.

A nurse asks a patient, "If you had fever and vomiting for 3 days, what would you do?" Which aspect of the mental status examination is the nurse assessing? a. Behavior b. Cognition c. Affect and mood d. Perceptual disturbances

ANS: B Assessing cognition involves determining a patient's judgment and decision making. In this case, the nurse would expect a response of "Call my doctor" if the patient's cognition and judgment are intact. If the patient responds, "I would stop eating" or "I would just wait and see what happened," the nurse would conclude that judgment is impaired. The other options refer to other aspects of the examination.

Before assessing a new patient, a nurse is told by another health care worker, "I know that patient. No matter how hard we work, there isn't much improvement by the time of discharge." The nurse's responsibility is to: a. document the other worker's assessment of the patient. b. assess the patient based on data collected from all sources. c. validate the worker's impression by contacting the patient's significant other. d. discuss the worker's impression with the patient during the assessment interview.

ANS: B Assessment should include data obtained from both the primary and reliable secondary sources. The nurse, bearing in mind the possible effects of counter-transference, should evaluate biased assessments by others as objectively as possible.

A patient presents to the emergency department with mixed psychiatric symptoms. The admission nurse suspects the symptoms may be the result of a medical problem. Lab results show elevated BUN (blood urea nitrogen) and creatinine. What is the nurse's next best action? a. Report the findings to the health care provider. b. Assess the patient for a history of renal problems. c. Assess the patient's family history for cardiac problems. d. Arrange for the patient's hospitalization on the psychiatric unit.

ANS: B Elevated BUN (blood urea nitrogen) and creatinine suggest renal problems. Renal dysfunction can often imitate psychiatric disorders. The nurse should further assess the patient's history for renal problems and then share the findings with the health care provider.

A new staff nurse completes an orientation to the psychiatric unit. This nurse will expect to ask an advanced practice nurse to perform which action for patients? a. Perform mental health assessment interviews. b. Prescribe psychotropic medication. c. Establish therapeutic relationships. d. Individualize nursing care plans.

ANS: B Prescriptive privileges are granted to master's-prepared nurse practitioners who have taken special courses on prescribing medication. The nurse prepared at the basic level performs mental health assessments, establishes relationships, and provides individualized care planning. Note that this question was also offered for Chapter 1.

Which entry in the medical record best meets the requirement for problem-oriented charting? a. "A: Pacing and muttering to self. P: Sensory perceptual alteration related to internal auditory stimulation. I: Given fluphenazine HCL (Prolixin) 2.5 mg po at 0900 and went to room to lie down. E: Calmer by 0930. Returned to lounge to watch TV." b. "S: States, 'I feel like I'm ready to blow up.' O: Pacing hall, mumbling to self. A: Auditory hallucinations. P: Offer haloperidol (Haldol) 2 mg po. I: Haloperidol (Haldol) 2 mg po given at 0900. E: Returned to lounge at 0930 and quietly watched TV." c. "Agitated behavior. D: Patient muttering to self as though answering an unseen person. A: Given haloperidol (Haldol) 2 mg po and went to room to lie down. E: Patient calmer. Returned to lounge to watch TV." d. "Pacing hall and muttering to self as though answering an unseen person. haloperidol (Haldol) 2 mg po administered at 0900 with calming effect in 30 minutes. Stated, 'I'm no longer bothered by the voices.'"

ANS: B Problem-oriented documentation uses the first letter of key words to organize data: S for subjective data, O for objective data, A for assessment, P for plan, I for intervention, and E for evaluation. The distracters offer examples of PIE charting, focus documentation, and narrative documentation.

"QSEN" refers to: a. Qualitative Standardized Excellence in Nursing b. Quality and Safety Education for Nurses c. Quantitative Effectiveness in Nursing d. Quick Standards Essential for Nurses

ANS: B QSEN represents national initiatives centered on patient safety and quality. The primary goal of QSEN is to prepare future nurses with the knowledge, skills, and attitudes to increase the quality, care, and safety in the health care setting in which they work.

A nurse wants to assess an adult patient's recent memory. Which question would best yield the desired information? a. "Where did you go to elementary school?" b. "What did you have for breakfast this morning?" c. "Can you name the current president of the United States?" d. "A few minutes ago, I told you my name. Can you remember it?"

ANS: B The patient's recall of a meal provides evidence of recent memory. Two incorrect responses are useful to assess immediate and remote memory. The other distracter assesses the patient's fund of knowledge.

After formulating the nursing diagnoses for a new patient, what is a nurse's next action? a. Designing interventions to include in the plan of care b. Determining the goals and outcome criteria c. Implementing the nursing plan of care d. Completing the spiritual assessment

ANS: B The third step of the nursing process is planning and outcome identification. Outcomes cannot be determined until the nursing assessment is complete and nursing diagnoses have been formulated.

A patient is very suspicious and states, "The FBI has me under surveillance." Which strategies should a nurse use when gathering initial assessment data about this patient? Select all that apply. a. Tell the patient that medication will help this type of thinking. b. Ask the patient, "Tell me about the problem as you see it." c. Seek information about when the problem began. d. Tell the patient, "Your ideas are not realistic." e. Reassure the patient, "You are safe here."

ANS: B, C, E During the assessment interview, the nurse should listen attentively and accept the patient's statements in a nonjudgmental way. Because the patient is suspicious and fearful, reassuring safety may be helpful, although trust is unlikely so early in the relationship. Saying that medication will help or telling the patient that the ideas are not realistic will undermine development of trust between the nurse and patient.

1. A nurse assessed a patient who reluctantly participated in activities, answered questions with minimal responses, and rarely made eye contact. What information should be included when documenting the assessment? Select all that apply. a. The patient was uncooperative b. The patient's subjective responses c. Only data obtained from the patient's verbal responses d. A description of the patient's behavior during the interview e. Analysis of why the patient was unresponsive during the interview

ANS: B, D Both content and process of the interview should be documented. Providing only the patient's verbal responses would create a skewed picture of the patient. Writing that the patient was uncooperative is subjectively worded. An objective description of patient behavior would be preferable. Analysis of the reasons for the patient's behavior would be speculation, which is inappropriate.

What information is conveyed by nursing diagnoses? Select all that apply. a. Medical judgments about the disorder b. Unmet patient needs currently present c. Goals and outcomes for the plan of care d. Supporting data that validate the diagnoses e. Probable causes that will be targets for nursing interventions

ANS: B, D, E Nursing diagnoses focus on phenomena of concern to nurses rather than on medical diagnoses.

An adolescent asks a nurse conducting an assessment interview, "Why should I tell you anything? You'll just tell my parents whatever you find out." Which response by the nurse is appropriate? a. "That isn't true. What you tell us is private and held in strict confidence. Your parents have no right to know." b. "Yes, your parents may find out what you say, but it is important that they know about your problems." c. "What you say about feelings is private, but some things, like suicidal thinking, must be reported to the treatment team." d. "It sounds as though you are not really ready to work on your problems and make changes."

ANS: C Adolescents are very concerned with confidentiality. The patient has a right to know that most information will be held in confidence but that certain material must be reported or shared with the treatment team, such as threats of suicide, homicide, use of illegal drugs, or issues of abuse. The incorrect responses are not true, will not inspire the confidence of the patient, or are confrontational.

A patient begins a new program to assist with building social skills. In which part of the plan of care should a nurse record the item, "Encourage patient to attend one psychoeducational group daily"? a. Assessment b. Analysis c. Implementation d. Evaluation

ANS: C Interventions are the nursing prescriptions to achieve the outcomes. Interventions should be specific.

When a new patient is hospitalized, a nurse takes the patient on a tour, explains rules of the unit, and discusses the daily schedule. The nurse is engaged in: a. counseling. b. health teaching. c. milieu management. d. psychobiological intervention.

ANS: C Milieu management provides a therapeutic environment in which the patient can feel comfortable and safe while engaging in activities that meet the patient's physical and mental health needs. Counseling refers to activities designed to promote problem solving and enhanced coping and includes interviewing, crisis intervention, stress management, and conflict resolution. Health teaching involves identifying health education needs and giving information about these needs. Psychobiological interventions involve medication administration and monitoring response to medications.

Select the most appropriate label to complete this nursing diagnosis: ___________ related to feelings of shyness and poorly developed social skills as evidenced by watching television alone at home every evening. a. Deficient knowledge b. Ineffective coping c. Social isolation d. Powerlessness

ANS: C Nursing diagnoses are selected based on the etiological factors and assessment findings, or evidence. In this instance, the evidence shows social isolation that is caused by shyness and poorly developed social skills.

A newly admitted patient diagnosed with major depression has gained 20 pounds over a few months and has suicidal ideation. The patient has taken an antidepressant medication for 1 week without remission of symptoms. Select the priority nursing diagnosis. a. Imbalanced nutrition: more than body requirements b. Chronic low self-esteem c. Risk for suicide d. Hopelessness

ANS: C Risk for suicide is the priority diagnosis when the patient has both suicidal ideation and a plan to carry out the suicidal intent. Imbalanced nutrition, hopelessness, and chronic low self-esteem may be applicable nursing diagnoses, but these problems do not affect patient safety as urgently as would a suicide attempt.

The desired outcome for a patient experiencing insomnia is, "Patient will sleep for a minimum of 5 hours nightly within 7 days." At the end of 7 days, review of sleep data shows the patient sleeps an average of 4 hours nightly and takes a 2-hour afternoon nap. The nurse will document the outcome as: a. consistently demonstrated. b. often demonstrated. c. sometimes demonstrated. d. never demonstrated.

ANS: D Although the patient is sleeping 6 hours daily, the total is not one uninterrupted session at night. Therefore, the outcome must be evaluated as never demonstrated. See relationship to audience response question.

Nursing behaviors associated with the implementation phase of nursing process are concerned with: a. participating in mutual identification of patient outcomes. b. gathering accurate and sufficient patient-centered data. c. comparing patient responses and expected outcomes. d. carrying out interventions and coordinating care.

ANS: D Nursing behaviors relating to implementation include using available resources, performing interventions, finding alternatives when necessary, and coordinating care with other team members.

The desired outcome for a patient experiencing insomnia is, "Patient will sleep for a minimum of 5 hours nightly within 7 days." At the end of 7 days, review of sleep data shows the patient sleeps an average of 4 hours nightly and takes a 2-hour afternoon nap. What is the nurse's next action? a. Continue the current plan without changes. b. Remove this nursing diagnosis from the plan of care. c. Write a new nursing diagnosis that better reflects the problem. d. Examine interventions for possible revision of the target date.

ANS: D Sleeping a total of 5 hours at night remains a reasonable outcome. Extending the period for attaining the outcome may be appropriate. Examining interventions might result in planning an activity during the afternoon rather than permitting a nap. Continuing the current plan without changes is inappropriate. Removing this nursing diagnosis from the plan of care would be correct when the outcome was met and the problem resolved. Writing a new nursing diagnosis is inappropriate because no other nursing diagnosis relates to the problem.

A nurse documents: "Patient is mute despite repeated efforts to elicit speech. Makes no eye contact. Inattentive to staff. Gazes off to the side or looks upward rather than at speaker." Which nursing diagnosis should be considered? a. Defensive coping b. Decisional conflict c. Risk for other-directed violence d. Impaired verbal communication

ANS: D The defining characteristics are more related to the nursing diagnosis of impaired verbal communication than to the other nursing diagnoses.

A nurse prepares to assess a new patient who moved to the United States from Central America three years ago. After introductions, what is the nurse's next comment? a. "How did you get to the United States?" b. "Would you like for a family member to help you talk with me?" c. "An interpreter is available. Would you like for me to make a request for these services?" d. "Are you comfortable conversing in English, or would you prefer to have a translator present?"

ANS: D The nurse should determine whether a translator is needed by first assessing the patient for language barriers. Accuracy of the assessment depends on the ability to communicate in a language that is familiar to the patient. Family members are not always reliable translators. An interpreter may change the patient's responses; a translator is a better resource.

A patient states, "I'm not worth anything. I have negative thoughts about myself. I feel anxious and shaky all the time. Sometimes I feel so sad that I want to go to sleep and never wake up." Which nursing intervention should have the highest priority? a. Self-esteem-building activities b. Anxiety self-control measures c. Sleep enhancement activitie d. Suicide precautions

ANS: D The nurse would place a priority on monitoring and reinforcing suicide self-restraint because it relates directly and immediately to patient safety. Patient safety is always a priority concern. The nurse should monitor and reinforce all patient attempts to control anxiety, improve sleep patterns, and develop self-esteem, while giving priority attention to suicide self-restraint.

Select the best outcome for a patient with the nursing diagnosis: Impaired social interaction related to sociocultural dissonance as evidenced by stating, "Although I'd like to, I don't join in because I don't speak the language very well." Patient will: a. show improved use of language. b. demonstrate improved social skills. c. become more independent in decision making. d. select and participate in one group activity per day.

ANS: D The outcome describes social involvement on the part of the patient. Neither cooperation nor independence has been an issue. The patient has already expressed a desire to interact with others. Outcomes must be measurable. Two of the distracters are not measurable.

Which statement made by a patient during an initial assessment interview should serve as the priority focus for the plan of care? a. "I can always trust my family." b. "It seems like I always have bad luck." c. "You never know who will turn against you." d. "I hear evil voices that tell me to do bad things."

ANS: D The statement regarding evil voices tells the nurse that the patient is experiencing auditory hallucinations and may create risks for violence. The other statements are vague and do not clearly identify the patient's chief symptom.

At what point in an assessment interview would a nurse ask, "How does your faith help you in stressful situations?" During the assessment of: a. childhood growth and development b. substance use and abuse c. educational background d. coping strategies

ANS: D When discussing coping strategies, the nurse might ask what the patient does when upset, what usually relieves stress, and to whom the patient goes to talk about problems. The question regarding whether the patient's faith helps deal with stress fits well here. It would be out of place if introduced during exploration of the other topics.

A nurse assesses an older adult patient brought to the emergency department by a family member. The patient was wandering outside saying, "I can't find my way home." The patient is confused and unable to answer questions. Select the nurse's best action. a. Record the patient's answers to questions on the nursing assessment form. b. Ask an advanced practice nurse to perform the assessment interview. c. Call for a mental health advocate to maintain the patient's rights. d. Obtain important information from the family member.

ANS: D When the patient (primary source) is unable to provide information, secondary sources should be used, in this case, the family member. Later, more data may be obtained from other information sources familiar with the patient. An advanced practice nurse is not needed for this assessment; it is within the scope of practice of the staff nurse. Calling a mental health advocate is unnecessary. See relationship to audience response question.

The nurse records this entry in a patient's progress notes: Patient escorted to unit by ER nurse at 2130. Patient's clothing was dirty. In interview room, patient sat with hands over face, sobbing softly. Did not acknowledge nurse or reply to questions. After several minutes, abruptly arose, ran to window, and pounded. Shouted repeatedly, "Let me out of here." Verbal intervention unsuccessful. Order for stat dose 2 mg haloperidol PO obtained; medication administered at 2150. By 2215, patient stopped shouting and returned to sit wordlessly in chair. Patient placed on one-to-one observation. How should this documentation be evaluated? a. Uses unapproved abbreviations b. Contains subjective material c. Too brief to be of value d. Excessively wordy e. Meets standards

ANS: E This narrative note describes patient appearance, behavior, and conversation. It mentions that less-restrictive measures were attempted before administering medication and documents patient response to medication. This note would probably meet standards. A complete nursing assessment would be in order as soon as the patient is able to participate. Subjective material is absent from the note. Abbreviations are acceptable.

Bethany, a nurse on the psychiatric unit, has a past history of alcoholism. She has weekly clinical supervision meetings with her mentor, the director of the unit. Which statement by Bethany to her mentor would indicate the presence of countertransference? A. "My patient, Miranda, is being discharged tomorrow. I provided discharge teaching and stressed the importance of calling the help line number should she become suicidal again." B. "My patient, Laney, has been abusing alcohol. I told her that the only way to recover was to go 'cold turkey' and to get away from her dysfunctional family and to do it now!" C. "My patient, Jack, started drinking after 14 years of sobriety. We are focusing on his treatment plan of attending AA meetings five times a week after discharge." D. "My patient, Gayle, is an elderly woman with depression. She calls me by her daughter's name because she says I remind her of her daughter."

B This statement indicates countertransference; Bethany may be overidentifying with the patient because of her own past history of alcoholism. She is providing adamant advice to the patient that, besides being nontherapeutic, may be more relevant to her own past than to the patient's. The discharge teaching for a patient being discharged and focusing on the treatment plan for the alcoholic patient are appropriate and show no signs of countertransference. The patient calling the nurse by her daughter's name is transference rather than countertransference.

Select the example of a tort. A.The plan of care for a patient is not completed within 24 hours of the patient's admission. B.A nurse gives a PRN dose of an antipsychotic drug to an agitated patient because the unit is short-staffed. C.An advanced practice nurse recommends hospitalization for a patient who is dangerous to self and others. D.A patient's admission status changed from involuntary to voluntary after the patient's hallucinations subside.

B A tort is a civil wrong against a person that violates his or her rights. Giving unnecessary medication for the convenience of staff controls behavior in a manner similar to secluding a patient; thus, false imprisonment is a possible charge. The other options do not exemplify torts.

An adolescent hospitalized after a violent physical outburst tells the nurse, "I'm going to kill my father, but you can't tell anyone." Select the nurse's best response. A. "You are right. Federal law requires me to keep clinical information private." B. "I am obligated to share that information with the treatment team." C. "Those kinds of thoughts will make your hospitalization longer." D. "You should share this thought with your psychiatrist."

B Breach of nurse-patient confidentiality does not pose a legal dilemma for nurses in these circumstances because a team approach to delivery of psychiatric care presumes communication of patient information to other staff members to develop treatment plans and outcome criteria. The patient should also know that the team has a duty to warn the father of the risk for harm.

Which nursing intervention demonstrates false imprisonment? A. A confused and combative patient says, "I'm getting out of here, and no one can stop me." The nurse restrains this patient without a health care provider's order and then promptly obtains an order. B. A patient has been irritating and attention-seeking much of the day. A nurse escorts the patient down the hall saying, "Stay in your room, or you'll be put in seclusion." C. An involuntarily hospitalized patient with suicidal ideation runs out of the psychiatric unit. The nurse rushes after the patient and convinces the patient to return to the unit. D. An involuntarily hospitalized patient with homicidal ideation attempts to leave the facility. A nurse calls the security team and uses established protocols to prevent the patient from leaving.

B False imprisonment involves holding a competent person against his or her will. Actual force is not a requirement of false imprisonment. The individual needs only to be placed in fear of imprisonment by someone who has the ability to carry out the threat. If a patient is not competent (confused), then the nurse should act with beneficence. Patients admitted involuntarily should not be allowed to leave without permission of the treatment team.

A patient diagnosed with schizophrenia believes a local minister stirred evil spirits. The patient threatens to bomb a local church. The psychiatrist notifies the minister. Select the answer with the correct rationale. The psychiatrist: A. released information without proper authorization. B. demonstrated the duty to warn and protect. C. violated the patient's confidentiality. D. avoided charges of malpractice.

B It is the health care professional's duty to warn or notify an intended victim after a threat of harm has been made. Informing a potential victim of a threat is a legal responsibility of the health care professional. It is not a violation of confidentiality.

Two hospitalized patients fight whenever they are together. During a team meeting, a nurse asserts that safety is of paramount importance, so treatment plans should call for both patients to be secluded to keep them from injuring each other. This assertion: A.reinforces the autonomy of the two patients. B.violates the civil rights of both patients. C.represents the intentional tort of battery. D.correctly places emphasis on safety.

B Patients have a right to treatment in the least restrictive setting. Safety is important, but less restrictive measures should be tried first. Unnecessary seclusion may result in a charge of false imprisonment. Seclusion violates the patient's autonomy. The principle by which the nurse is motivated is beneficence, not justice. The tort represented is false imprisonment.

A patient experiencing psychosis asks a psychiatric technician, "What's the matter with me?" The technician replies, "Nothing is wrong with you. You just need to use some self-control." The nurse who overheard the exchange should take action based on: A. the technician's unauthorized disclosure of confidential clinical information. B. violation of the patient's right to be treated with dignity and respect. C. the nurse's obligation to report caregiver negligence. D. the patient's right to social interaction.

B Patients have the right to be treated with dignity and respect. The technician's comment disregards the seriousness of the patient's illness. The Code of Ethics for Nurses requires intervention. Patient emotional abuse has been demonstrated, not negligence. An interaction with the technician is not an aspect of social interaction. The technician did not disclose clinical information.

A nurse prepares to administer a scheduled injection of haloperidol decanoate (Haldol depot) to an outpatient with schizophrenia. As the nurse swabs the site, the patient shouts, "Stop! I don't want to take that medicine anymore. I hate the side effects." Select the nurse's best action. A. Assemble other staff for a show of force and proceed with the injection, using restraint if necessary. B. Stop the medication administration procedure and say to the patient, "Tell me more about the side effects you've been having." C. Proceed with the injection but explain to the patient that there are medications that will help reduce the unpleasant side effects. D. Say to the patient, "Since I've already drawn the medication in the syringe, I'm required to give it, but let's talk to the doctor about delaying next month's dose."

B Patients with mental illness retain their civil rights unless there is clear, cogent, and convincing evidence of dangerousness. The patient in this situation presents no evidence of dangerousness. The nurse, as an advocate and educator, should seek more information about the patient's decision and not force the medication.

Which action by a nurse constitutes a breach of a patient's right to privacy? A. Documenting the patient's daily behavior during hospitalization B. Releasing information to the patient's employer without consent C. Discussing the patient's history with other staff during care planning D. Asking family to share information about a patient's pre-hospitalization behavior

B Release of information without patient authorization violates the patient's right to privacy. The other options are acceptable nursing practices. See relationship to audience response question.

A nurse finds a psychiatric advance directive in the medical record of a patient experiencing psychosis. The directive was executed during a period when the patient was stable and competent. The nurse should: A.review the directive with the patient to ensure it is current. B.ensure that the directive is respected in treatment planning. C.consider the directive only if there is a cardiac or respiratory arrest. D.encourage the patient to revise the directive in light of the current health problem.

B The nurse has an obligation to honor the right to self-determination. An advanced psychiatric directive supports that goal. Since the patient is currently psychotic, the terms of the directive now apply.

An aide in a psychiatric hospital says to the nurse, "We don't have time every day to help each patient complete a menu selection. Let's tell dietary to prepare popular choices and send them to our unit." Select the nurse's best response. A. "Thanks for the suggestion, but that idea may not work because so many patients take MAOI (monoamine oxidase inhibitor) antidepressants." B. "Thanks for the idea, but it's important to treat patients as individuals. Giving choices is one way we can respect patients' individuality." C. "Thank you for the suggestion, but the patients' bill of rights requires us to allow patients to select their own diet." D. "Thank you. That is a very good idea. It will make meal preparation easier for the dietary department."

B The nurse's response to the aide should recognize patients' rights to be treated with dignity and respect as well as promote autonomy. This response also shows respect for the aide and fulfills the nurse's obligation to provide supervision of unlicensed personnel. The incorrect responses have flawed rationale or do not respect patients as individuals.

A nurse should perceive an intense, highly emotional communication style as culturally appropriate for a client who is A. African American. B. Hispanic American. C. Asian American. D. British American

B. Highly emotional verbal communication accompanied by dramatic body language when describing emotional problems is a style associated with persons of Hispanic culture. French and Italian Americans also demonstrate animated facial expressions and expressive hand gestures during communication.

What therapeutic communication technique is the nurse using by asking a newly admitted patient, "Can you tell me what was happening to you that led to your being hospitalized here?" A. Using a minimal encourager B. Using an open-ended question C. Paraphrasing D. Reflecting

B. Open-ended questions require more than one-word answers.

You are caring for William, a 55-year-old patient who recently came to the United States from England on a work visa. He was admitted for severe depression following the death of his wife from cancer 2 weeks ago. While telling you about his wife's death and how it has affected him, William shows little emotion. Which of the following explanations is most plausible? A. William did not love his wife. B. William's response may reflect cultural norms. C. William's response may reflect guilt. D. William may have an antisocial personality, which would explain his lack of feeling.

B. Showing little emotion while in distress may be a cultural phenomenon. Some cultures, such as the British and German cultures, tend to value highly the concept of self-control and may show little facial emotion in the presence of emotional turmoil. There is no evidence to suggest the patient did not love his wife, and this would be jumping to conclusions. There is also nothing in the scenario to suggest guilt and there is no evidence in the scenario to suggest antisocial personality disorder.

The content and direction of the clinical interview is determined by the A. nurse. B. client. C. physician. D. health care team.

B. The client always takes the lead and determines the content and direction of the clinical interview, although the nurse may discourage social conversation or intrusive personal questioning.

What is the most helpful nursing response to a client who reports thinking of dropping out of college because it is too stressful? A. "Don't let them beat you! Fight back!" B. "School is stressful. What do you find most stressful?" C. "I know just what you are going through. The stress is terrible." D. "You have only two more semesters. You will be glad if you stick it out."

B. This response acknowledges the speaker's perception of school as difficult and asks for further information. This response suggests the nurse is listening actively and is concerned.

On the basis of the current understanding of neurotransmitters, the nurse can view a client's symptoms of profound depression as likely related in part to A. increased dopamine level. B. decreased serotonin level. C. increased norepinephrine level. D. decreased acetylcholine level.

B. A lowered serotonin level is highly supported as being related to depression; however, depression is more probably influenced by a number of neurotransmitter abnormalities.

The physician tells a client suspected of experiencing obessive-complusive disorder that "We want to do an imaging study that will tell us which parts of your brain are particularly active." From this explanation, the nurse can determine that the physician will order a(n) A. computed tomography scan. B. positron emission tomography scan. C. ventriculogram. D. electroencephalogram.

B. A positron emission tomography scan detects brain activity. The other imaging studies are limited to visualization of structures.

Which of the following is classified as a circadian rhythm? A. Sex drive B. Sleep cycle C. Skeletal muscle contraction D. Maintenance of a focused stream of consciousness

B. Circadian rhythms are biological rhythms that influence specific regulatory functions such as body temperature, sleeping and waking, and the secretion of certain hormones and neurotransmitters.

A client is admitted to the hospital experiencing severe depression. The nurse recognizes the possibility that depression may be related to a stress-induced hormonal imbalance associated with A. luteinizing hormone. B. cortisol. C. gronadotropin. D. clomipramine.

B. Cortisol is a hormone released during periods of stress.

Which statement about diagnosis of a mental disorder is true? a. The symptoms of each disorder are common among all cultures. b. Culture may cause variations in symptoms for each clinical disorder. c. All mental disorders listed in the DSM-5 are seen in all other cultures. d. Psychiatric diagnoses are listed in separately from other physical disorders in a five axes system.

B. Every society has its own view of health and illness and the types of behavior categorized as mental illness. Culture also influences the symptoms of a particular disorder. For example, individuals of certain cultures are more likely to express depression through somatic symptoms than through affect and feeling tone. The five axes system was abandoned in this edition of the DSM-5.

In order to best differentiate whether an Asian client is demonstrating a mental illness when attempting suicide is to A. ask the client whether he views himself as being depressed. B. identify his culture's view regarding suicide. C. explain to him that suicide is often regarded as a desperate act. D. assess the client for other examples of depressive behaviors.

B. One approach to differentiating mental health from mental illness is to consider what a particular culture regards as acceptable or unacceptable. In this view, the mentally ill are those who violate social norms and thus threaten (or make anxious) those observing them. For example, traditional Japanese may consider suicide to be an act of honor, and Middle Eastern "suicide bombers" are considered holy warriors or martyrs. Contrast these viewpoints with Western culture, where people who attempt or complete suicides are nearly always considered mentally ill.

The term pharmacodynamics refers to the effect of the drug on the body, while pharmacokinetics refers to: A. the effect of the drug specifically on the brain and movement. B. the effect of the person on the drug. C. the effect of the drug on children and adolescents. D. the effect of the drug on the half-life and ability of the liver to excrete.

B. Pharmacokinetics refers to the effect of the person on the drug and helps to guide dosing. The other options are incorrect.

Julie, a 49-year-old patient diagnosed with schizophrenia at 22 years old, is taking risperidone (Risperdal). Which of the following nursing assessments is the priority assessment with Julie? A. Monitoring blood levels to avoid toxicity B. Monitoring for abnormal involuntary movements C. Observing for secondary mania D. Observing for memory changes

B. Risperidone has the highest rate of extrapyramidal side effects (EPSs) of the second-generation antipsychotic medications, thus making it imperative to monitor for EPSs. Risperidone is not monitored with blood levels and does not cause mania or memory changes.

A client tells the mental health nurse "I am terribly frightened! I hear whispering that someone is going to kill me." Which criterion of mental health can the nurse assess as lacking? A. Control over behavior B. Appraisal of reality C. Effectiveness in work D. Healthy self-concept

B. The appraisal of reality is lacking for this client. The client does not have a picture of what is happening around himself or herself.

Homeostasis is promoted by interaction between the brain and internal organs mediated by A. conscious behavior. B. the autonomic nervous system. C. the sympathetic nervous system. D. the parasympathetic nervous system.

B. The function of the autonomic nervous system is to transmit messages between the brain and the internal organs. This linkage promotes the maintenance of homeostasis.

Which organs secrete hormones that are a normal component of the body's general response to stress? A. Brain, thyroid gland, pancreas B. Brain, pituitary gland, adrenal glands C. Pituitary gland, pancreas, thyroid gland D. Adrenal glands, parathyroid glands

B. The hypothalamus, pituitary, and adrenal glands act as a system that responds to mental and physical stress. The three hormones secreted—corticotropin-releasing hormone, corticotropin, and cortisol—influence the function of nerve cells of the brain.

Which imaging technique can provide information about brain function? A. Computed tomography (CT) scan B. Positron emission tomography (PET) scan C. Magnetic resonance imaging (MRI) scan D. Skull radiograph

B. The positron emission tomography scan provides information about function; the other imaging techniques provide information about structure.

These severe mental illnesses are recognized across cultures: a. antisocial and borderline personality disorders. b. schizophrenia and bipolar disorder. c. bulimia and anorexia nervosa. d. amok and social phobia.

B. Worldwide studies indicate that both schizophrenia and bipolar disorder are recognized cross-culturally.

The preferred seating arrangement for a nurse-client interview is with A. the nurse behind a desk and the client in a chair in front of the desk. B. the nurse and client sitting at a 90-degree angle to each other. C. the client sitting in a chair and the nurse standing a few feet away. D. the nurse and client sitting facing each other.

B. This arrangement allows the nurse to observe the client but places no barriers between the principals. The two are at the same height, so neither is in an inferior position. Face-to-face seating is a more confrontational arrangement and therefore more anxiety producing.

Which statement best explains the term "worldview"?

Beliefs and values held by people of a given culture about what is good, right, and normal. --A worldview is a system of thinking about how the world works and how people should behave in the world and toward each other. It is from this view that people develop beliefs, values, and the practices that guide their lives.

The nurse is finding it difficult to provide structure and set limits for a client. The nurse should self-evaluate for boundary blurring. value dissonance. covert anger. empathy.

Boundary blurring is often signaled by the nurse being either too helpful or not helpful enough.

Your patient, Emma, is crying in your one-to-one session while telling you of her father's recent death from a car accident. Which of the following responses illustrates empathy? A. "Emma, I'm so sorry. My father died two years ago, so I know how you are feeling." B. "Emma, you need to focus on yourself right now. You deserve to take time just for you." C. "Emma, that must have been such a hard situation to deal with." D. "Emma, I know that you will get over this. It just takes time."

C This response reflects understanding of the patient's feelings, which is empathy. Feeling sorry for the client represents sympathy, whereas not addressing the patient's concern belittles the patient's feelings of grief she is expressing by changing the subject. Telling the patient she will get over it does not reflect empathy and is closed-ended.

A voluntarily hospitalized patient tells the nurse, "Get me the forms for discharge. I want to leave now." Select the nurse's best response. A. "I will get the forms for you right now and bring them to your room." B. "Since you signed your consent for treatment, you may leave if you desire." C. "I will get them for you, but let's talk about your decision to leave treatment." D. "I cannot give you those forms without your health care provider's permission."

C A voluntarily admitted patient has the right to demand and obtain release in most states. However, as a patient advocate, the nurse is responsible for weighing factors related to the patient's wishes and best interests. By asking for information, the nurse may be able to help the patient reconsider the decision. Facilitating discharge without consent is not in the patient's best interests before exploring the reason for the request.

After leaving work, a nurse realizes documentation of administration of a PRN medication was omitted. This off-duty nurse phones the nurse on duty and says, "Please document administration of the medication for me. My password is alpha1." The nurse receiving the call should: A. fulfill the request promptly. B. document the caller's password. C. refer the matter to the charge nurse to resolve. D. report the request to the patient's health care provider.

C Fraudulent documentation may be grounds for discipline by the state board of nursing. Referring the matter to the charge nurse will allow observance of hospital policy while ensuring that documentation occurs. Notifying the health care provider would be unnecessary when the charge nurse can resolve the problem. Nurses should not provide passwords to others.

Which individual diagnosed with a mental illness may need involuntary hospitalization? An individual: A. who has a panic attack after her child gets lost in a shopping mall B. with visions of demons emerging from cemetery plots throughout the community C. who takes 38 acetaminophen tablets after the person's stock portfolio becomes worthless D. diagnosed with major depression who stops taking prescribed antidepressant medication

C Involuntary hospitalization protects patients who are dangerous to themselves or others and cannot care for their own basic needs. Involuntary hospitalization also protects other individuals in society. An overdose of acetaminophen indicates dangerousness to self. The behaviors described in the other options are not sufficient to require involuntary hospitalization.

A new antidepressant is prescribed for an elderly patient with major depression, but the dose is more than the usual geriatric dose. The nurse should: A. consult a reliable drug reference. B. teach the patient about possible side effects and adverse effects. C. withhold the medication and confer with the health care provider. D. encourage the patient to increase oral fluids to reduce drug concentration.

C The dose of antidepressants for elderly patients is often less than the usual adult dose. The nurse should withhold the medication and consult the health care provider who wrote the order. The nurse's duty is to practice according to professional standards as well as intervene and protect the patient.

In which situations would a nurse have the duty to intervene and report? Select all that apply. A. A peer has difficulty writing measurable outcomes. B. A health care provider gives a telephone order for medication. C. A peer tries to provide patient care in an alcohol-impaired state. D. A team member violates relationship boundaries with a patient. E. A patient refuses medication prescribed by a licensed health care provider.

C, D Both keyed answers are events that jeopardize patient safety. The distracters describe situations that may be resolved with education or that are acceptable practices.

Which actions violate the civil rights of a psychiatric patient? The nurse: (select all that apply) A. performs mouth checks after overhearing a patient say, "I've been spitting out my medication." B. begins suicide precautions before a patient is assessed by the health care provider. C. opens and reads a letter a patient left at the nurse's station to be mailed. D. places a patient's expensive watch in the hospital business office safe. E. restrains a patient who uses profanity when speaking to the nurse.

C, E The patient has the right to send and receive mail without interference. Restraint is not indicated because a patient uses profanity; there are other less restrictive ways to deal with this behavior. The other options are examples of good nursing judgment and do not violate the patient's civil rights.

With which client should the nurse make the assessment that not using touch would probably be in the client's best interests? A. A recent immigrant from Russia B. A deeply depressed client C. A Chinese American client D. A tearful client reporting pain

C. Chinese Americans may not like to be touched by strangers.

When determining the appropriateness of touching a psychiatric client, the nurse should A. follow his or her instincts concerning touching individual clients. B. touch the elderly but avoid touching the young. C. check the facility's policy on the acceptability of touch. D. perceive touch as a gesture of warmth and friendship that fosters a relationship.

C. Students are urged to check the policy manual of their facilities, because some facilities have a no-touch policy, particularly with adolescents and children who may have experienced inappropriate touch and would not know how to interpret the touch of the health care worker.

When considering the interaction between verbal and nonverbal communication, what is the best word to complete this analogy: Verbal communication relates to content as nonverbal communication relates to A. touch. B. conflict. C. process. D. double messages.

C. The verbal message is sometimes referred to as the content of the message, and the nonverbal behavior is called the process of the message.

A nurse's identification badge includes the term, "Psychiatric Mental Health Nurse." A client with a history of paranoia asks, "What does that title mean?" The nurse responds best by answering: a. "Don't be afraid; it means I'm here to help, not hurt, you." b. "Psychiatric mental health nurses care for people with mental illnesses." c. "We have the specialized skills needed to care for those with mental illnesses." d. "The nurses who work in mental health facilities have that title."

C. A psychiatric mental health nurse has specialized nursing skills and implements the nursing process to manage and deliver nursing care to the mentally ill. The remaining options either do not effectively answer the client's question or assume that the question is the result of the client's paranoia.

The nurse caring for a client prescribed an antipsychotic medication that produces anticholinergic side effects will assess for A. sedation, drowsiness, hypotension, and weight gain. B. orthostatic hypotension and memory dysfunction. C. blurred vision, dry mouth, and constipation. D. tremors, tachycardia, and ejaculatory dysfunction.

C. Anticholinergic effects are the effects produced by atropine: dry mouth, dry eyes, blurred vision, constipation, and urinary retention.

Vanessa's provider writes orders including medication to treat her depression. Based on current understanding of brain physiology, which of the following neurotransmitters would you expect to see targeted with the medication ordered? A. dopamine B. GABA C. serotonin/norepinephrine D. Acetylcholine

C. Antidepressant medication targets serotonin and norepinephrine. Dopamine is implicated in schizophrenia (increase) and Parkinson's disease (decrease). GABA is implicated in anxiety disorders. Acetylcholine is implicated in Alzheimer's disease as well as Huntington's disease and Parkinson's disease.

You have graduated with your BSN degree and have taken your first job on a psychiatric unit after becoming a licensed Registered Nurse. You are providing teaching to Mason, a newly admitted patient on the psychiatric unit, regarding his daily schedule. Which of the following would not be an appropriate teaching statement? A. "You will participate in unit activities and groups daily." B. "You will be given a schedule daily of the groups we would like you to attend." C. "You will attend a psychotherapy group that I lead." D. "You will see your provider daily in a one-to-one session."

C. Basic level RNs cannot perform psychotherapy. The other options are all appropriate expectations of a patient's schedule on a psychiatric unit.

Which branch of epidemiology is the nurse involved in when seeking outcomes for patients whose depression was treated with electroconvulsive therapy (ECT)? a. experimental b. descriptive c. clinical d. analytic

C. Clinical epidemiology represents a broad field that addresses what happens to people with illnesses who are seen by providers of clinical care. Studies use traditional epidemiological methods and are conducted in groups that are usually defined by illness or symptoms or by diagnostic procedures or treatments given for the illness or symptoms.

Which of the following patients would need monitoring for potential development of the side effect of hypothyroidism? A. Janelle, who is taking Prozac B. Travis, who is taking Depakote C. Shelly, who is taking lithium D. Anna, who is taking Risperdal

C. Long-term use of lithium may cause hypothyroidism. The other options refer to drugs whose long-term use do not cause hypothyroidism.

The mental health status of a particular client can best be assessed by considering A. the degree of conformity of the individual to society's norms. B. the degree to which an individual is logical and rational. C. placement on a continuum from health to illness. D. the rate of intellectual and emotional growth.

C. Many (but not all) of the most prevalent and disabling mental disorders have been found to have strong biological influences. Therefore, these disorders can be regarded as "diseases." Visualizing these disorders along the mental health continuum is helpful.

A nursing diagnosis for a client with a psychiatric disorder serves the purpose of A. justifying the use of certain psychotropic medication. B. providing data essential for insurance reimbursement. C. providing a framework for selecting appropriate interventions. D. completing the medical diagnostic statement.

C. Nursing diagnoses provide the framework for identifying appropriate nursing interventions for dealing with the phenomena a client with a mental health disorder is experiencing.

Which of the following best demonstrates parity related to mental health care? A. The client is admitted for a 72-hour mental hygiene evaluation. B. Advance practice nurse can be certified as psychiatric nurse specialist. C. A client's mental health coverage is equal to his medical/surgical coverage. D. A client who has attempted suicide is hospitalized for a mental health evaluation.

C. Parity refers to equivalence that requires insurers who provide mental health coverage to offer annual and lifetime benefits at the same level provided for medical/surgical coverage.

The behavior of an individual who seems unable to learn right from wrong and who repeatedly violates laws and lies demonstrates problems related to the brain's inability to A. regulate conscious mental activity. B. retain and recall past experience. C. regulate social behavior. D. maintain homeostasis.

C. The inability to regulate social behavior usually results in antisocial behaviors such as lying, cheating, taking advantage of others, and breaking laws.

A nursing assistant shares with the nurse that a client with schizophrenia is as difficult to communicate with as "someone with Alzheimer's." The nurse offers the following advice: A. "Try talking to him early in the day to get the best results. Fatigue disorganizes his thinking." B. "Schizophrenia and Alzheimer's disease both cause irreversible brain damage, so keep your conversations short when you talk to a client with either disorder." C. "His medication targets his disturbed thought and speech patterns. To maximize improvement he will need positive interactions and support." D. "Make sure he eats the comfort foods he is served because they increase serotonin production and will help normalize his thoughts and speech."

C. This response will help the nursing assistant understand that improvement can be expected in the client's condition and that this improvement can be maximized by therapeutic interactions with staff. It establishes the expectation that the nursing assistant will interact in a therapeutic manner.

You enter the room of Andrea, a patient on the psychiatric unit. Andrea is sitting with her arms crossed over her chest and her left leg rapidly moving up and down, and she has an angry expression on her face. When you approach her, she states harshly, "I'm fine! Everything's great." Which of the following is true regarding verbal and nonverbal communication? A. Verbal communication is always more accurate than nonverbal communication. B. Verbal communication is more straightforward, whereas nonverbal communication does not portray what a person is thinking. C. Nonverbal and verbal communication may be different; nurses must pay attention to the nonverbal communication being presented to get an accurate message. D. Nonverbal communication is about 10% of all communication, and verbal communication is about 90%.

C. Communication is roughly 10% verbal and 90% nonverbal, so nurses must pay close attention to nonverbal cues to accurately assess what the patient is really feeling. The other options are all untrue of verbal and nonverbal communication and are actually the opposite of what is believed of communication.

Of the following environments, which would be most conducive to a therapeutic session? A. The nurses' station B. A table in the coffee shop C. A quiet section of the day room D. The utility room

C. Of the options provided, a quiet corner of the day room offers the safest, quietest, most private environment for a therapeutic encounter.

When the client sits about 5 feet away from the nurse during the assessment interview, the nurse interprets that the client views the nurse as a A. safe person to interact with. B. new friend. C. stranger. D. peer.

C. Social distance (4-12 feet) is reserved for strangers or acquaintances. This is often the client's perception of staff during the initial phase of relationship-building.

The quantitative study of the distribution of mental disorders in human populations is called a. mortality. b. prevalence. c. epidemiology. d. clinical epidemiology.

C. Epidemiology is the quantitative study of the distribution of mental disorders in human populations. Mortality refers to deaths. Prevalence refers to the proportion of a population with a mental disorder at a given time. Clinical epidemiology deals with what happens to people with illnesses who are seen by providers of care.

The nurse would NOT address which of the following goals in attempting to establish a therapeutic nurse-client relationship? A. Assisting the client with self-care needs when appropriate. B. Helping the client identify self-defeating behaviors. C. Providing the client with opportunities to socialize. D. Facilitating the client's communication of disturbing feelings or thoughts. E. Encouraging the client to make decisions when appropriate.

C. Providing the client with opportunities to socialize. Addressing the client's need to socialize is not one of the goals of establishing a therapeutic relationship. The other options are goals addressed in a therapeutic relationship.

Which source of healing might be most satisfactory to a client who believes his illness is caused by spiritual forces?

Cleansings -- Rituals, cleansings, prayer, and even witchcraft may be the treatment expectation of a client who believes his illness is caused by spiritual forces.

In the process of trying new values, which step shows the highest commitment to the value? Cherishing the value Publicly stating affirmation of the value Choosing a stand consistent with the value from among several alternatives Consistently acting in ways that repeatedly affirm the value

Consistently acting in ways that repeatedly affirm the value Values clarification theory puts acting consistently on one's belief as the highest level of the process, following prizing and choosing.

You are working with Allison on the inpatient psychiatric unit. Which of the following statements reflect an accurate understanding during which phase of the nurse-patient relationship the issue of termination should first be discussed? A. "Allison, you are being discharged today, so I'd like to bring up the subject of termination—discussing your time here and summarizing what coping skills you have attained." (to fellow nurse): B. "I haven't met my new patient Allison yet, but I am working through my feelings of anxiety in dealing with a patient who wanted to kill herself." C. "Allison, now that we are working on your problem-solving skills and behaviors you'd like to change, I'd like to bring up the issue of termination." D. "Allison, now that we've discussed your reasons for being here and how often we will meet, I'd like to talk about what we will do at the time of your discharge."

D The issue of termination is brought up first in the orientation phase. All the other options describe other phases of the nurse-patient relationship—the termination phase, the preorientation phase, and the working phase.

Willis has been admitted to your inpatient psychiatric unit with suicidal ideation. He resides in a halfway house after being released from prison, where he was sent for sexually abusing his teenage stepdaughter. In your one-to-one session he tells you of his terrible guilt over the situation and wanting to die because of it. Which of the following responses you could make reflects a helpful trait in a therapeutic relationship? A. "It's good that you feel guilty. That means you still have a chance of being helped." B. "Of course you feel guilty. You did a horrendous thing. You shouldn't even be out of prison." C. "The biggest question is, will you do it again? You will end up right back in prison, and have even worse guilt feelings because you hurt someone again." D. "You are suffering with guilt over what you did. Let's talk about some goals we could work on that may make you want to keep living."

D This response demonstrates suspending value judgment, a helpful trait in establishing and maintaining a therapeutic relationship. Although it is difficult, nurses are more effective when they don't use their own value systems to judge patients' thoughts, feelings, or behaviors. The other options are all judgmental responses. Judgment on the part of the nurse will most likely interfere with further explorations of feelings and hinder the therapeutic relationship.

A newly admitted acutely psychotic patient is a private patient of the medical director and a private-pay patient. To whom does the psychiatric nurse assigned to the patient owe the duty of care? A. Medical director B. Hospital C. Profession D. Patient

D Although the nurse is accountable to the health care provider, the agency, the patient, and the profession, the duty of care is owed to the patient.

What is the legal significance of a nurse's action when a patient verbally refuses medication and the nurse gives the medication over the patient's objection? The nurse: A. has been negligent. B. committed malpractice. C. fulfilled the standard of care. D. can be charged with battery.

D Battery is an intentional tort in which one individual violates the rights of another through touching without consent. Forcing a patient to take medication after the medication was refused constitutes battery. The charge of battery can be brought against the nurse. The medication may not necessarily harm the patient; harm is a component of malpractice.

A patient with psychosis became aggressive, struck another patient, and required seclusion. Select the best documentation. A. Patient struck another patient who attempted to leave day room to go to bathroom. Seclusion necessary at 1415. Plan: Maintain seclusion for 8 hours and keep these two patients away from each other for 24 hours. B. Seclusion ordered by physician at 1415 after command hallucinations told the patient to hit another patient. Careful monitoring of patient maintained during period of seclusion. C. Seclusion ordered by MD for aggressive behavior. Begun at 1415. Maintained for 2 hours without incident. Outcome: Patient calmer and apologized for outburst. D. Patient pacing, shouting. Haloperidol 5 mg given PO at 1300. No effect by 1315. At 1415 patient yelled, "I'll punch anyone who gets near me," and struck another patient with fist. Physically placed in seclusion at 1420. Seclusion order obtained from MD at 1430.

D Documentation must be specific and detail the key aspects of care. It should demonstrate implementation of the least restrictive alternative. Justification for why a patient was secluded should be recorded, along with interventions attempted in an effort to avoid seclusion. Documentation should include a description of behavior and verbalizations, interventions tried and their outcomes, and the name of the health care provider ordering the use of seclusion.

Which patient meets criteria for involuntary hospitalization for psychiatric treatment? The patient who: A. is noncompliant with the treatment regimen. B. fraudulently files for bankruptcy. C. sold and distributed illegal drugs. D. threatens to harm self and others.

D Involuntary hospitalization protects patients who are dangerous to themselves or others and cannot care for their own basic needs. Involuntary commitment also protects other individuals in society. The behaviors described in the other options are not sufficient to require involuntary hospitalization.

Which documentation of a patient's behavior best demonstrates a nurse's observations? A. Isolates self from others. Frequently fell asleep during group. Vital signs stable. B. Calmer; more cooperative. Participated actively in group. No evidence of psychotic thinking. C. Appeared to hallucinate. Frequently increased volume on television, causing conflict with others. D. Wore four layers of clothing. States, "I need protection from evil bacteria trying to pierce my skin."

D The documentation states specific observations of the patient's appearance and the exact statements made. The other options are vague or subjective statements and can be interpreted in different ways.

A family member of a patient with delusions of persecution asks the nurse, "Are there any circumstances under which the treatment team is justified in violating a patient's right to confidentiality?" The nurse should reply that confidentiality may be breached: A. under no circumstances. B. at the discretion of the psychiatrist. C. when questions are asked by law enforcement. D. if the patient threatens the life of another person.

D The duty to warn a person whose life has been threatened by a psychiatric patient overrides the patient's right to confidentiality. The right to confidentiality is not suspended at the discretion of the therapist or for legal investigations.

In a team meeting a nurse says, "I'm concerned about whether we are behaving ethically by using restraint to prevent one patient from self-mutilation, while the care plan for another self-mutilating patient requires one-on-one supervision." Which ethical principle most clearly applies to this situation? A.Beneficence B.Autonomy C.Fidelity D.Justice

D The nurse is concerned about justice, that is, fair distribution of care, which includes treatment with the least restrictive methods for both patients. Beneficence means promoting the good of others. Autonomy is the right to make one's own decisions. Fidelity is the observance of loyalty and commitment to the patient.

Which individual with mental illness may need emergency or involuntary admission? The individual who: A. resumes using heroin while still taking naltrexone (ReVia). B. reports hearing angels playing harps during thunderstorms. C. does not keep an outpatient appointment with the mental health nurse. D. throws a heavy plate at a waiter at the direction of command hallucinations.

D Throwing a heavy plate is likely to harm the waiter and is evidence of dangerousness to others. This behavior meets the criteria for emergency or involuntary hospitalization for mental illness. The behaviors in the other options evidence mental illness but not dangerousness. See related audience response question.

After a client discusses her relationship with her father, the nurse asks, "Tell me if I'm correct that you feel dominated and controlled by him?" The nurse's purpose is to A. elicit more information. B. encourage evaluation. C. verbalize the implied. D. clarify message.

D. Clarification helps the nurse understand and correctly interpret the client's message. It gives the client the opportunity to correct misconceptions.

Recent immigrants to the United States from which country would find direct eye contact a positive therapeutic technique? A. Korea B. Mexico C. Japan D. Germany

D. Eye contact conveys interest to most northern European individuals. Eye contact would be considered intrusive to the others.

Which statement by the nurse reflects the process occurring in the clinical interview? A. "Give me an example of something your wife does that 'drives you nuts.'" B. "What makes you think your doctor will give you a pass?" C. "When is your child custody hearing going to be held?" D. "You are frowning. What are you feeling?"

D. Process refers to nonverbal behavior. Nonverbal behavior is often a more accurate gauge of client feelings than what is being verbalized.

A client being medicated for both hallucinations and delusions reports being drowsy. The nurse will correctly interpret this symptom as related to the drug's effect on the brain's ability to regulate A. mood. B. thought. C. memory. D. sleep.

D. A number of psychotropic drugs have side effects that interfere with the brain's ability to regulate sleep alertness. These side effects range from lethargy to extreme drowsiness. As the client's body becomes accustomed to the drug, the drowsiness should dissipate.

The prevalence rate over a 12-month period for major depressive disorder is a. lower than the prevalence rate for panic disorders. b. greater than the prevalence rate for psychotic disorders. c. equal to the prevalence rate for psychotic disorders. d. greater than the prevalence rate for generalized anxiety.

D. Statistics show that the prevalence rate over a 12-month period for major depressive disorder is 6.7%, and the lifetime prevalence rate for generalized anxiety is 3.1%.

When discussing her husband, a client shares that "I would be better off alone. At least I would be able to come and go as I please and not have to be interrogated all the time." What therapeutic communication technique is the nurse using when responding, "Are you saying that things would be better if you left your husband?" A. Focusing B. Restating C. Reflection D. Clarification

D. Clarification verifies the nurse's interpretation of the client's message.

Which communication techniques should the nurse use with a client who has been identified as having difficulty expressing thoughts and feelings? A. Using emotionally charged words and gestures B. Offering opinions and avoiding periods of silence C. Asking closed-ended questions requiring "yes" or "no" answers D. Asking open-ended questions and seeking clarification

D. Open-ended questions give the client the widest possible latitude in answering. Also, the client can take the lead in the interview. Seeking clarification helps the client clarify his or her own thoughts and promotes mutual understanding.

During a therapeutic encounter the nurse remarks to a client, "I noticed anger in your voice when you spoke of your father. Tell me about that." What communication techniques is the nurse using? A. Giving information and encouraging evaluation B. Presenting reality and encouraging planning C. Clarifying and suggesting collaboration D. Reflecting and exploring

D. Reflecting conveys the nurse's observations of the client when a sensitive issue is being discussed. Exploring seeks to examine a certain idea more fully.

During a clinical interview the client falls silent after disclosing that she was sexually abused as a child. The nurse should A. quickly break the silence and encourage the client to continue. B. reassure the client that the abuse was not her fault. C. reach out and gently touch the client's arm. D. allow the client to break the silence.

D. Silence is not a "bad" thing. It gives the speaker time to think through a point or collect his or her thoughts.

You enter the room of Andrea, a patient on the psychiatric unit. Andrea is sitting with her arms crossed over her chest and her left leg rapidly moving up and down, and she has an angry expression on her face. When you approach her, she states harshly, "I'm fine! Everything's great." Which of the following responses would be therapeutic? A. "Okay, but we are all here to help you, so come get one of the staff if you need to talk." B. "I'm glad everything is good. I am going to give you your schedule for the day and we can discuss how the groups are going." C. "I don't believe you. You are not being truthful with me." D. "It looks as though you are saying one thing but feeling another. Can you tell me what may be upsetting you?"

D. This response uses the therapeutic technique of clarifying; it addresses the difference between the patient's verbal and nonverbal communication and encourages sharing of feelings. The other options do not address the patient's obvious distress or are confrontational and judgmental.

During a therapeutic encounter, the nurse makes an effort to ensure the use of two congruent levels of communication. What is the rationale for this? A. The mental image of a word may not be the same for both nurse and client. B. One statement may simultaneously convey conflicting messages. C. Many of the client's remarks are no more than social phrases. D. Content of messages may be contradicted by process.

D. Verbal messages may be contradicted by the nonverbal message that is conveyed. The nonverbal message is usually more consistent with the client's feelings than the verbal message.

Ms. Wong, aged 52 years, comes to the emergency room with severe anxiety. She was raised in China but immigrated to the United States at age 40 years. She was recently fired from her job because of a major error in the accounting department that she managed. Ms. Wong's aged parents live with her. Ms. Wong states, "I am a failure." What statement may accurately assess the basis for Ms. Wong's anxiety and feelings of failure? Ms. Wong may feel that she has shamed the family by being fired and may no longer be able to provide for them.

Ms. Wong may feel that she has shamed the family by being fired and may no longer be able to provide for them. --Eastern tradition, such as in China, where Ms. Wong is from, sees the family as the basis for one's identity, and family interdependence as the norm. The views expressed in options a and c demonstrate Western tradition where self-reliance, individuality, and autonomy are highly valued. In the Eastern view one is born into an unchangeable fate.

Which of the following best explains the concept of cultural competence?

Nurses adjust their own practices to meet their patients' cultural preferences, beliefs, and practices. -- Cultural competence means that nurses adjust and conform to their patients' cultural needs, beliefs, practices, and preferences rather than their own. This option does not describe cultural competence. Although nurses are continually learning regarding culture, it is a career-long process. The goal is not to educate patients about our own culture but rather to adjust to their cultural preferences. Although nurses may take continuing education regarding culture, this does not describe the term cultural competence. The other options do not describe cultural competence.

During what stage of the therapeutic nurse-client relationship is a formal or informal contract between the nurse and client established? Preorientation Orientation Working Termination

Orientation Contracting is part of the orientation phase of the relationship. Establishing the operational "rules" provides a foundation for the relationship.

According to the Western scientific view of health, illness is the result of

Pathogens --Disease has a cause (e.g., pathogens, toxins) that creates the effect; disease can be observed and measured.

Which healing practice is least used in the Western health system of healing practices?

Restoring lost balance or harmony --The best treatment perspectives of various cultures include regaining lost balance and harmony. This perspective is not used in Western culture.

The phase of the nurse-client relationship that may cause anxieties to reappear and past losses to be reviewed is the preorientation phase. orientation phase. working phase. termination phase.

Termination, a stage in which the client must face the loss or ending of the therapeutic relationship, often reawakens the pain of earlier losses.

Which idea held by the nurse would best promote the provision of culturally competent care?

Western biomedicine is one of several established healing systems. -- A nurse who holds this belief would be likely be open to a variety of established interventions. In truth, nurses cannot apply a standard model of assessment, diagnosis, and intervention to all clients with equal confidence. This leads to culturally irrelevant interventions.

The psychiatric mental health nurse working with depressed clients of the Eastern culture must realize that a useful outcome criterion might be if client reports

appeasement of the spirits. --Appeasement of spirits might be a viable outcome criterion if the client believes the illness was caused by angry spirits. In each of the other options useful outcomes would be decreased somatic symptoms, reinstatement of energy balance, and decreased anxiety.

People who have an indigenous worldview

are concerned with being part of a harmonious community. --Clients with an indigenous worldview are interested in connectedness and being in harmony with others. They have little interest in personal goals and autonomy.

According to Rogers, a synonym for genuineness is respect. empathy. congruence. positive regard.

congruence. Genuineness refers to self-awareness of one's feelings as they arise within the relationship and the ability to communicate them when appropriate. It is the ability to meet others person-to-person without hiding behind roles. Rogers uses the word congruence to signify genuineness.

A client reports that her mother-in-law is very intrusive. The nurse responds, "I know how you feel. My mother-in-law is nosy, too." The nurse is demonstrating self-disclosure in an appropriate way. to the client permission to continue. countertransference. empathy to establish trust.

countertransference. Countertransference refers to the stirring up of feelings in the nurse by the client.

The outcome of the nurse's expressions of sympathy instead of empathy toward the client often leads to enhanced client coping. lessening of client emotional pain. increased hope for client improvement. decreased client communication.

decreased client communication. Sympathy and the resulting projection of the nurse's feelings limits the client's opportunity to further discuss the problem.

When members of a group are introduced to the culture's worldview, beliefs, values, and practices, it is called

enculturation. --Members of a group are introduced to the culture's worldview, beliefs, values, and practices in a process called enculturation. Ethnocentrism is the universal tendency of humans to think that their way of thinking and behaving is the only correct and natural way. Acculturation is learning the beliefs, values, and practices of a new cultural setting, which sometimes takes several generations. Cultural encounters occur when members of varying cultures meet and interact.

The Eastern tradition, disease is believed to be caused by

fluctuations in opposing forces. -- In the Eastern tradition, disease is believed to be caused by fluctuations in opposing forces, the yin-yang energies.

An action that is acceptable in a social relationship but not in a therapeutic relationship is giving advice. listening actively. clarifying feelings. giving positive regard.

giving advice. Giving and receiving advice is acceptable in a social relationship. In a therapeutic relationship, it is appropriate for the nurse to assist the client in exploring alternative solutions to problems and in making his or her own decisions.

The Eastern world view can be identified by the belief that

holds responsibility to family as central. --The Eastern traditional world view is sociocentric. Individuals experience their selfhood and their lives as part of an interdependent web of relationships and expectations.

The psychiatric nurse planning and implementing care for culturally diverse clients should understand

holistic theory. -- In most cultures a holistic perspective prevails, one without separation of mind and body.

Deviation from cultural expectations is considered by members of the cultural group as a demonstration of

illness. --Deviation from cultural expectations is considered by others in the culture to be a problem and is frequently defined by the cultural group as "illness."

When assessing and planning treatment for a client who has recently arrived in the United States from China, the nurse should be alert to the possibility that the client's explanatory model for his illness reflects

imbalance. --Many Eastern cultures explain illness as a function of imbalance.

Exclusive use of Western psychological theories by nurses making client assessments will result in

inadequate assessment of clients of diverse cultures. --Unless clients have faith in a particular healing modality, the treatment may not be effective. When nurses make assessments on the basis of Western theories, treatments consistent with those assessments follow. Clients of other cultures may find the treatment modalities unacceptable or not useful. Treatments consistent with the client's cultural beliefs as to what will provide a cure are better.

Clients of another culture are at greatest risk for misdiagnosis of a psychiatric problem because of

insensitive interviewing techniques. Correct --Inaccurate information or insufficient information may be obtained if the interviewer is not culturally sensitive. Only when assessment data are accurate can effective treatment be planned.

A client reporting gastric pain, tells the nurse, "I think my symptoms started when a neighbor cast a spell on me." The assessment the nurse can make is that the client

is expressing a culture-bound illness. --Many culture-bound illnesses, such as ghost illness, or hwa byung, seem exotic or irrational to American nurses. Many of these illnesses cannot be understood within a Western medicine framework. Their causes, manifestations, and treatments do not make sense to nurses whose understanding is limited to a Western perspective on disease and illness.

One of the possible sources of boundary violations is placing the focus on meeting the nurse's needs. identifying client disturbances. assessing the client's ego strength. assessing the client's weaknesses.

meeting the nurse's needs. Boundary violations have two sources: (1) allowing the therapeutic relationship to slip into a social relationship, and (2) meeting the nurse's personal needs at the expense of the client's needs.

A client states "That nurse nevers seems comfortable being with me." The nurse can be described as not seeming genuine to the client. transmitting fear of clients. unfriendly and aloof. controlling.

not seeming genuine to the client. Hiding behind a role, using stiff or formal interactions, and creating distance between self and client suggest a nurse is lacking in genuineness, or the ability to interact in a person-to-person fashion.

The use of empathy and support begins in the stage of the nurse-client relationship termed the orientation stage. working stage. identification stage. resolution stage.

orientation stage. The use of empathy and support should begin in the orientation stage. These tools are helpful in building trust and furthering the relationship.

A client tells the nurse "I really feel close to you. You are like the friend I never had." The nurse can assess this statement as indicating the client may be experiencing congruence. empathetic feelings. countertransference. positive transference.

positive transference Transference involves the client experiencing feelings toward a nurse that belong to a significant person in the client's past.

Data concerning client age, sex, education, and income should be the focus of an assessment in order to best understand cultural issues related to

power and control. Correct -- Power and control are often products of culturally determined beliefs about who should hold power. In many cultures the elderly are venerated. In other cultures women are virtually powerless. For some cultures, higher education equates with power.

The pre-orientation phase of the nurse-client relationship is characterized by the nurse's focus on self-analysis of strengths, limitations, and feelings. clarification of the nursing role. changing the client's dysfunctional behavior. incorporating coping skills into client's routine.

self-analysis of strengths, limitations, and feelings. During the preorientation phase the nurse prepares for a relationship with a client by engaging in self-examination.

Josefina Juarez, aged 36 years, comes to the mental health clinic where you work after being referred by her primary care provider. Josefina came to live in the United States from Brazil 5 years ago. She is now a single mother to 6 children, ages 2 to 15, following the death of her husband last year. During the initial intake assessment, Josefina tells you her problem is that she has headaches and backaches "almost every day" and "can't sleep at night." She shakes her head no and looks away when asked about anxiety or depression and states she does not know why she was referred to the mental health clinic. You recognize that Josefina may be exhibiting:

somatization. --Somatization is described as experiencing and expressing emotional or psychological distress as physical symptoms. Regression is a defense mechanism meaning to begin to function at a lower or previous level of functioning. Enculturation refers to how cultural beliefs, practices, and norms are communicated to its members. Assimilation refers to a situation in which immigrants adapt to and absorb the practices and beliefs of a new culture until these customs are more natural than the ones they learned in their homeland.

To help a client develop his or her resources, the nurse must first be aware of the client's strengths. negative transferences. countertransferences. resistances.

the client's strengths. Nurses work to bolster a client's strengths, to identify areas of dysfunction, and to assist in the development of new coping strategies.

The orientation phase of the nurse-client relationship focuses on the nurse identifying personal biases. the nurse and client identifying client needs. overcoming resistance to changing behavior. reviewing situations that occurred in previous meetings.

the nurse and client identifying client needs. The orientation phase is the first stage of the nurse-client relationship and focuses on, among other things, the identification of client needs.

When a nurse and client meet informally or have an otherwise limited but helpful relationship, the relationship is referred to as a(n) crisis intervention. therapeutic encounter. autonomous interaction. preorientation phenomenon.

therapeutic encounter. A therapeutic encounter is a short but helpful interaction between the nurse and client.

Client reactions of intense hostility or feelings of strong affection toward the nurse are common forms of resistance. transference. countertransference. emotional abreaction.

transference. The stirring up of feelings in the client by the nurse is referred to as transference.

The primary difference between a social and a therapeutic relationship is the type of information exchanged. amount of satisfaction felt. type of responsibility involved. amount of emotion invested.

type of responsibility involved. In a therapeutic relationship the nurse assumes responsibility for focusing the relationship on the client's needs, facilitating communication, assisting the client with problem- solving, and helping the client identify and test alternative coping strategies.

When a nurse is biased against a client, those feelings will likely make it difficult to assess the client's symptoms. assess boundary issues with the client. view the client with positive regard. engage in values clarification with the client.

view the client with positive regard. Whenever a nurse harbors negative feelings about a client, these feelings stand in the way of objectivity and reduce his or her ability to give the client positive regard.